Jacqueline Denise Washington, MENTAL HEALTH

Key facts

NPI

1801670831

Entity type

Individual (NPI type 1)

Primary specialty

Adult Mental Health Clinic/Center 261QM0850X

Practice address

224 Dallas St
Gary, IN 46406-1327

Phone

(219) 248-5307

NPI assigned

Aug 21, 2023

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

Other names

• Jacqueline Denise Washington Professional name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 21, 2023.

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1801670831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 DALLAS ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464061327",
            "telephone_number": "219-248-5307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 DALLAS ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464061327",
            "telephone_number": "219-248-5307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHINGTON",
        "first_name": "JACQUELINE",
        "middle_name": "DENISE",
        "credential": "MENTAL HEALTH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "WASHINGTON",
            "middle_name": "DENISE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Gary, IN

• Karin Adine Warden-Thomas, FNP-BC
• Deanna Ione Ware
• Michelle Ware
• Renita Ware
• Audric Ranel Warren, MS, ATC, PES, CES
• Mark Alan Washington, M.D.
• Yassmine Washington
• Michelle Wathier, NP
• Channae Watkins, NP
• Neil Lawrence Watkins, MD

All providers in Gary, IN · Adult Mental Health Clinic/Center in Indiana