Emily Kristin Jackson, LPC-MH, NCC, QMHP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC-MH30714 Issued in SD

Practice address

1110 E 77TH St
Sioux Falls, SD 57108-3020

Phone

(605) 275-0009

NPI assigned

Nov 22, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeastern Behavioral Healthcare

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sioux Falls, SD
  • NPI 1114002573
  NPD (past)
• Southeastern Behavioral Healthcare

  • Community/Behavioral Health Agency
  • Sioux Falls, SD
  • NPI 1689948317
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1750048013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 S LINEDRIVE AVE APT 107",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571104127",
            "telephone_number": "712-261-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 E 77TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571083020",
            "telephone_number": "605-275-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EMILY",
        "middle_name": "KRISTIN",
        "credential": "LPC-MH, NCC, QMHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-22",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SD",
            "license": "LPC-MH30714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rose Izuchi, M.D., MPH
• J Brockhoff Therapy Services LLC
• Bassel Jabbour, M.D
• Wallace J Jackmon, PHD
• Cassandra Ray Jackson, MD
• Wendy Marie Jackson, PHARM. D
• Shefaly A Jacob, MD
• John Lewis Jacobs, PA
• Leah Jacobs
• Mitchell Wade Jacobs, D.C.

• Mental Health Counselor in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Mental Health Counselor in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.