Active NPI
Christine Jackson, LLPC
- Professional Counselor
- Holland, MI
National Provider Identifier
1861730020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401013371
- Practice address
- 355 Settlers Rd
Holland, MI 49423-3704 - Phone
- (616) 796-9595
- Fax
- (616) 796-9596
- NPI assigned
- Jan 23, 2013
- Last updated
- Jan 24, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401013371 | MI | Primary |
Addresses
Primary practice location
355 Settlers Rd
Holland, MI 49423-3704
Mailing address
40 Jefferson Ave SE
Grand Rapids, MI 49503-4304
Phone (616) 456-1443
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401013371 | MI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities West Michigan | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Catholic Social Services
- Clinical Social Worker
- Grand Rapids, MI
- NPI 1245303809
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358985600000",
"number": "1861730020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 JEFFERSON AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034304",
"telephone_number": "616-456-1443",
"fax_number": "616-732-6392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "355 SETTLERS RD",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494233704",
"telephone_number": "616-796-9595",
"fax_number": "616-796-9596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHRISTINE",
"credential": "LLPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-23",
"last_updated": "2013-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401013371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.