Keith Ellis Jackson, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

48284 Issued in CA

Practice address

7600 NE 41St St Ste 200
Vancouver, WA 98662-6772

Phone

(360) 852-8139

NPI assigned

Mar 6, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 2

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": "1614988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1881289338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 NE 13TH PL",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986659534",
            "telephone_number": "360-852-8139",
            "fax_number": "360-852-8139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 NE 41ST ST STE 200",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626772",
            "telephone_number": "360-852-8139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEITH",
        "middle_name": "ELLIS",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-06",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "LF61192417",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "48284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Vancouver",
            "affiliation": "Y",
            "affiliationName": "Mind Solutions LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3311 NE Mlk Blvd",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972122086",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Vancouver",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3311 NE Mlk Blvd",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972122086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dean Robert Jackson, LMP
• Emma Jackson
• Heidi Ericka Jackson, RN
• Jasmine Kay Jackson
• Jefferson T Jackson
• Liberty Zariah Jackson, OTR/L
• Makenah Lorraine Jackson
• Morgan Jackson, MD
• Orenthal James Jackson Jr.
• Rick Lee Jackson, M.D.

• Marriage & Family Therapist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Marriage & Family Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; 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.