NPIMap

Organization Active NPI

Ebony C Jackson LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Denham Springs, LA
National Provider Identifier
1821470188
Registry record updated Jun 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
9158 Issued in LA
Legal business name
EBONY C JACKSON LLC
Practice address
23791 Southpoint Dr
Denham Springs, LA 70726-6856
Phone
(225) 369-2617
NPI assigned
Jun 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2015

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

Authorized official

Name
Miss Ebony Conerly Jackson, LCSW, BACSNPI 1730564279
Title
Social Worker
Phone
(225) 284-6249

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 9158 LA Primary

Addresses

Primary practice location

23791 Southpoint Dr
Denham Springs, LA 70726-6856

Mailing address

23791 Southpoint Dr
Denham Springs, LA 70726-6856
Phone (225) 369-2617

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435017600000",
    "number": "1821470188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23791 SOUTHPOINT DR",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707266856",
            "telephone_number": "225-369-2617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23791 SOUTHPOINT DR",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707266856",
            "telephone_number": "225-369-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBONY C JACKSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-23",
        "last_updated": "2015-06-23",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "EBONY",
        "authorized_official_middle_name": "CONERLY",
        "authorized_official_title_or_position": "SOCIAL WORKER",
        "authorized_official_telephone_number": "225-284-6249",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "LCSW, BACS"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "LA",
            "license": "9158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denham Springs, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; 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.