Diane R Jackson

Primary specialty

Pastoral CounselorTaxonomy code 101YP1600X

License

E.0003808-SUPV Issued in OH

Practice address

87 W 4TH St
Mansfield, OH 44903-1672

Phone

(419) 526-4603

Fax

(419) 526-4603

NPI assigned

Dec 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Samaritan House Counseling Services, LLC

  • Pastoral Counselor
  • Mansfield, OH
  • NPI 1568521300
  NPD (past)

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1811056658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1573",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449011573",
            "telephone_number": "419-526-4603",
            "fax_number": "419-526-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 W 4TH ST",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449031672",
            "telephone_number": "419-526-4603",
            "fax_number": "419-526-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DIANE",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-07",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "E.0003808-SUPV",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.0003808-SUPV",
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "OH",
            "license": "E.0003808-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Istanich
• Timothy J Iten, D.D.S.
• Edward T Jachym, DMD
• Daniel S Jackman, CDCA
• Darcy Jackson
• Katika Lashea Jackson
• Mary Louise Jackson
• Phillip A Jackson Sr.
• Tamika Lashawn Jackson
• Tonya L. Jackson

• Pastoral Counselor in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Pastoral Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.