Active NPI
Cheryl Jack, LCDC
- Addiction (Substance Use Disorder) Counselor
- Texas City, TX
National Provider Identifier
1861913469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 13802
- Practice address
- 3201 FM 2004 Rd
Texas City, TX 77591-2199 - Phone
- (409) 944-4399
- NPI assigned
- Jul 5, 2017
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 13802 | TX | Primary |
Addresses
Primary practice location
3201 FM 2004 Rd
Texas City, TX 77591-2199
Mailing address
3222 Rippling Falls LN
Dickinson, TX 77539-6175
Phone (409) 370-6482
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499212800000",
"number": "1861913469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3222 RIPPLING FALLS LN",
"city": "DICKINSON",
"state": "TX",
"postal_code": "775396175",
"telephone_number": "409-370-6482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 FM 2004 RD",
"city": "TEXAS CITY",
"state": "TX",
"postal_code": "775912199",
"telephone_number": "409-944-4399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "CHERYL",
"credential": "LCDC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-05",
"last_updated": "2017-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "13802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texas City, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.