Alfaye Jackson, PLPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2015044726 Issued in MO

Practice address

104 Fox Creek Rd
Rolla, MO 65401-3620

Phone

(417) 693-2770

NPI assigned

Aug 7, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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

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.

• Eustasis Foundation, Inc

  • Voluntary or Charitable Agency
  • Springfield, MO
  • NPI 1386257780
  NPD (past)
• Honour Brite LLC

  • Multi-Specialty Clinic/Center
  • Springfield, MO
  • NPI 1548760820
  NPD (past)
• Right Path Counseling, LLC

  • Mental Health Counselor
  • Springfield, MO
  • NPI 1588167902
  NPD (past)

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

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1770749905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 FOX CREEK RD",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654013620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 FOX CREEK RD",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654013620",
            "telephone_number": "417-693-2770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALFAYE",
        "name_prefix": "Ms.",
        "credential": "PLPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-07",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2008015070",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2015044726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "490047336",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Impact Lifeline
• Invision Family Eye Care
• Fauzia Iqbal, MD
• Jesse D Irwin, ATC
• Isd Renal Inc
• Karl Jacobs
• Autumn Marie Jaeger, PHARMD
• Cherie James, CHW-C
• Donald L James, DO
• Sherry James, LPC

• Professional Counselor in Rolla, MO
• Providers in Rolla, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.