Bryan Michael Jackson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6851117238 Issued in MI

Practice address

170 College Ave Ste 310
Holland, MI 49423-2982

Phone

(616) 426-9034

NPI assigned

Aug 30, 2023

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Second Story Counseling II LLC

  • Counselor
  • Hudsonville, MI
  • NPI 1013460716
  NPD

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

{
    "created_epoch": "1693353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1750166435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 COLLEGE AVE STE 310",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494232982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 COLLEGE AVE STE 310",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494232982",
            "telephone_number": "616-426-9034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRYAN",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-30",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851117238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Intercare Community Health Network
• Jessica Irvin
• Yelena V Isayenko, M.D.
• Lindsey Jo Iverson, LLMSW
• Gloria Izurieta
• Christine Jackson, LLPC
• Susan Jackson
• Samantha Jacobs
• Michael P Jacquemin, OD
• Rebecca A Jacquemin, OD

• Clinical Social Worker in Holland, MI
• Providers in Holland, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.