Active NPI
Deja Jackson
- Behavior Technician
- Port St Lucie, FL
National Provider Identifier
1760051080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1801 SE Hillmoor Dr Ste B101-103
Port St Lucie, FL 34952-7553 - Phone
- (772) 463-0444
- NPI assigned
- Jun 21, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | FL | Primary | |
| Behavior Analyst | 103K00000X | GA |
Addresses
Primary practice location
1801 SE Hillmoor Dr Ste B101-103
Port St Lucie, FL 34952-7553
Mailing address
6568 NW Cloverdale Ave
Port St Lucie, FL 34987-5849
Phone (678) 392-0109
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavior Basics, Incorporated | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Behavior Analyst
- Port St Lucie, FL
- NPI 1538406616
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786320000000",
"number": "1760051080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6568 NW CLOVERDALE AVE",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349875849",
"telephone_number": "678-392-0109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 SE HILLMOOR DR STE B101-103",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349527553",
"telephone_number": "772-463-0444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEJA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-21",
"last_updated": "2026-08-10",
"certification_date": "2026-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": null,
"primary": true
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "GA",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.