Active NPI
Beverly Jackson, LCPC
- Mental Health Counselor
- Missoula, MT
National Provider Identifier
1720008444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 625
- Practice address
- 210 N Higgins Ave
316
Missoula, MT 59802-4462 - Phone
- (406) 542-1313
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 625 | MT | Primary |
Addresses
Primary practice location
210 N Higgins Ave
316
Missoula, MT 59802-4462
Mailing address
1440 Mountain View Dr
Missoula, MT 59802-3358
Phone (406) 549-6789
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 625 | Other | MT | MT STATE LICENSE |
| 75135 | Other | MT | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 625 | MT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720008444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 MOUNTAIN VIEW DR",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598023358",
"telephone_number": "406-549-6789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 N HIGGINS AVE",
"address_2": "316",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598024462",
"telephone_number": "406-542-1313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BEVERLY",
"name_prefix": "Ms.",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MT",
"license": "625",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MT STATE LICENSE",
"identifier": "625",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "75135",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.