Active NPI
Sheryl R Jackson, PHD
- Clinical Psychologist
- Colleyville, TX
National Provider Identifier
1871523308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 33305
- Practice address
- 1215 Hall-Johnson Rd
Ste 100
Colleyville, TX 76034 - Phone
- (817) 909-7995
- Fax
- (817) 428-9885
- NPI assigned
- Jul 3, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1447 | AL | |
| Clinical Psychologist | 103TC0700X | 33305 | TX | Primary |
Addresses
Primary practice location
1215 Hall-Johnson Rd
Ste 100
Colleyville, TX 76034
Mailing address
2765 Mesquite LN
Grapevine, TX 76051-7166
Phone (682) 223-1026
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R99502 | Other | AL | VIVA |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1447 | AL | MD | Clinical Psychologist |
| 33305 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Alabama Health Services Foundation, PC. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Psychologist
- Colleyville, TX
- NPI 1639354046
-
- Multi-Specialty Clinic/Center
- Birmingham, AL
- NPI 1093768723
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871523308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2765 MESQUITE LN",
"city": "GRAPEVINE",
"state": "TX",
"postal_code": "760517166",
"telephone_number": "682-223-1026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1215 HALL-JOHNSON RD",
"address_2": "STE 100",
"city": "COLLEYVILLE",
"state": "TX",
"postal_code": "76034",
"telephone_number": "817-909-7995",
"fax_number": "817-428-9885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHERYL",
"middle_name": "R",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AL",
"license": "1447",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "33305",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIVA",
"identifier": "R99502",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colleyville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.