Mary Jackson, LPC-22257

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-22257 Issued in AZ

Practice address

404 W Aero Dr
Payson, AZ 85541-5407

Phone

(928) 474-3303

NPI assigned

Jul 18, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Undefined Non-Physician Type (Specify)

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Group practices

Southwest Behavioral Health Services IncGroup PAC ID 9739075854, 49 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Southwest Behavioral Health Services Inc

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1144384389
  Medicare reassignment Care Compare group NPD
• Southwest Behavioral Health Services, Inc.

  • Psychiatric Residential Treatment Facility
  • Kingman, AZ
  • NPI 1023556339
  NPD
• Southwest Behavioral Health Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lake Havasu City, AZ
  • NPI 1407139413
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1881374684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W AERO DR",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415407",
            "telephone_number": "928-474-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W AERO DR",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415407",
            "telephone_number": "928-474-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "credential": "LPC-22257",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-18",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-22257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ray Dauson Hughes, M.D.
• Judith A Hunt, M.D.
• Ideal Therapies, PLLC
• Ivan D. McLaws, DPM
• Jaber Abawi MD Inc
• Loran C Jacobs Jr., CRNA
• Kelsey Marie Jeffries
• Eldon W Jenkins
• John Bravo Dacanay MD PC
• Benjamin Patrick Johnson, MD

• Professional Counselor in Payson, AZ
• Providers in Payson, AZ by specialty
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.