Amanda Jackson, MHR LPC

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

4045 NW 64TH St Ste 520
Oklahoma City, OK 73116-8608

Phone

(405) 842-4911

NPI assigned

Aug 8, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Community Pathways Unlimited Inc

  • Clinical Psychologist
  • Oklahoma City, OK
  • NPI 1659328284
  Medicare reassignment NPD
• Multi County Counseling, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wewoka, OK
  • NPI 1285792630
  NPD (past)

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

{
    "created_epoch": "1407456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1760891295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 NW 64TH ST STE 520",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731168608",
            "telephone_number": "405-842-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 NW 64TH ST STE 520",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731168608",
            "telephone_number": "405-842-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMANDA",
        "credential": "MHR LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-08",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "LPC07226",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carmen Jackson-Heath
• Chasity Jade Jackson-Thompson
• Alexandra Jackson
• Alexandria Faith Jackson
• Alicia J Jackson, MASSAGE THERAPIST
• Andrea Bessie Jackson
• Andrea Luthelle Jackson, M.S. EDUCATION
• Anthony D Jackson, M.D.
• Camille Catherine Jackson, M.D.
• Candice Jackson

• Case Manager/Care Coordinator in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Case Manager/Care Coordinator in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.