Active NPI
Carl Edward Jackson, M.S. LPC
- Professional Counselor
- Altus, OK
National Provider Identifier
1891078671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6694
- Practice address
- 120 W Broadway St
Altus, OK 73521-3802 - Phone
- (580) 954-5966
- NPI assigned
- Sep 28, 2011
- Last updated
- Oct 8, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 6694 | OK | Primary |
Addresses
Primary practice location
120 W Broadway St
Altus, OK 73521-3802
Mailing address
120 W Broadway St
Altus, OK 73521-3802
Phone (580) 954-5966
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
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Open Arms Behavioral Health, LLC | 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.
-
- Community/Behavioral Health Agency
- Lawton, OK
- NPI 1962699983
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602115200000",
"number": "1891078671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 W BROADWAY ST",
"city": "ALTUS",
"state": "OK",
"postal_code": "735213802",
"telephone_number": "580-954-5966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 W BROADWAY ST",
"city": "ALTUS",
"state": "OK",
"postal_code": "735213802",
"telephone_number": "580-954-5966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CARL",
"middle_name": "EDWARD",
"credential": "M.S. LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-28",
"last_updated": "2020-10-08",
"certification_date": "2020-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OK",
"license": "6694",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Altus, OK
- Jackson County Memorial Hospital Authority (JCMH Pediatric Clinic)
- Jackson County Memorial Hospital Authority (Jackson County Memorial Hospital Home Care)
- Jackson County Memorial Hospital Authority (JCMH Women's Health Associates)
- Jackson County Memorial Hospital Skilled Nursing Facility
- Amber Dawn Jackson, MS, CCC-SLP
- Sara Lafawn Jackson, M.S. LPC
- James H Burns DC PC
- Taylor Nicole January, MED, LPC
- JCMH Healthcare Corporation (JCMH Scanner)
- JCMH Home Health Products Inc. (Home Health Products)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.