Active NPI
Nastassia S Jackson, LPC-IT
- Mental Health Counselor
- Milwaukee, WI
National Provider Identifier
1720524341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 7435
- Practice address
- 6830 W Villard Ave Ste 190
Milwaukee, WI 53218 - Phone
- (262) 320-7886
- NPI assigned
- Jan 7, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2601 | WI | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| School Counselor | 101YS0200X | |||
| Mental Health Counselor | 101YM0800X | 7435 | WI | Primary |
Addresses
Primary practice location
6830 W Villard Ave Ste 190
Milwaukee, WI 53218
Mailing address
PO Box 12922
Milwaukee, WI 53212-0922
Phone (414) 265-6156
Other practice location 1
3753 N 87th St
Milwaukee, WI 53222-2838
Phone (414) 265-6156
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100071680 | Medicaid | WI |
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 |
|---|---|---|---|
| 7435 | WI | MD | Mental Health Counselor |
| 2601 | WI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560816000000",
"number": "1720524341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12922",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532120922",
"telephone_number": "414-265-6156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6830 W VILLARD AVE STE 190",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53218",
"telephone_number": "262-320-7886"
}
],
"practiceLocations": [
{
"address_1": "3753 N 87th St",
"address_purpose": "LOCATION",
"city": "Milwaukee",
"state": "WI",
"postal_code": "532222838",
"country_code": "US",
"telephone_number": "414-265-6156",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "NASTASSIA",
"middle_name": "S",
"name_prefix": "Ms.",
"credential": "LPC-IT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-07",
"last_updated": "2019-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "2601",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "7435",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100071680",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.