Camilla Vawn Jackson, LMFT, LPC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

4732 Issued in TX

Practice address

1006 Guadalupe St Apt 5C
Kerrville, TX 78028-4915

Phone

(830) 496-1419

NPI assigned

Feb 20, 2007

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

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": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1841335916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 GUADALUPE STREET #5C",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "78028",
            "telephone_number": "713-240-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 GUADALUPE ST APT 5C",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780284915",
            "telephone_number": "830-496-1419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6750 West Loop South #675",
            "address_purpose": "LOCATION",
            "city": "Bellaire",
            "state": "TX",
            "postal_code": "77401",
            "country_code": "US",
            "telephone_number": "713-240-4433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CAMILLA",
        "middle_name": "VAWN",
        "name_prefix": "Ms.",
        "credential": "LMFT, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-20",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "4732",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "18405",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1841335916",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Innovacare Texas Urgent Care PLLC
• Linda M. Irion, R.D., L.D.
• Bryan Lee Ishmael, MSN, APRN, FNP-C
• J M Barnett MD PA
• Jackson Clinic of Chiropractic, Inc.
• Cynthia Lynn Jackson, PT
• Devin Nicole Jackson
• Ronald Evans Jackson, D.C.
• Jennifer A Jaeger, LPC
• Deborah A. Jalbert, P.A.

• Marriage & Family Therapist in Kerrville, TX
• Providers in Kerrville, TX by specialty
• Marriage & Family Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; 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.