Crystal Amber Jackson

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

15788-RAC Issued in CA

Practice address

412 E Tunnell St
Santa Maria, CA 93454-4146

Phone

(805) 925-0315

NPI assigned

Jun 21, 2022

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1821729880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 CARMEN LN",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587729",
            "telephone_number": "805-332-4568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 E TUNNELL ST",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544146",
            "telephone_number": "805-925-0315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CRYSTAL",
        "middle_name": "AMBER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-21",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1452921221",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "15788-RAC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033665526",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Isom, LCSW
• Jasmyn Isomura
• Michael Issa, DDS
• Nadine Rose Ivora
• Elisa Raquel Ixcol
• Jamecia Jackson
• Cheryl Jacobsen
• Richard Michael Jacobson, CAODC 7794
• Naresh Jaggi
• Maria D Jaimes-Perez

• Addiction (Substance Use Disorder) Counselor in Santa Maria, CA
• Providers in Santa Maria, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.