Richard Brendan Jackson, LPC, LMAC-T

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

03696 Issued in KS

Practice address

6221 Richards Dr
Shawnee, KS 66216-1724

Phone

(913) 248-1943

NPI assigned

Nov 17, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

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

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wyandot Center for Community Behavioral Healthcare IncGroup PAC ID 5496745325, 17 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 and National Provider Directory roles.

• Wyandot Center for Community Behavioral Healthcare, Inc.

  • Community/Behavioral Health Agency
  • Kansas City, KS
  • NPI 1629159389
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1912500554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 RICHARDS DR",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662161724",
            "telephone_number": "913-248-1943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6221 RICHARDS DR",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662161724",
            "telephone_number": "913-248-1943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RICHARD",
        "middle_name": "BRENDAN",
        "name_prefix": "Mr.",
        "credential": "LPC, LMAC-T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KS",
            "license": "00906-T",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KS",
            "license": "03696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria K Ittycheri, DO
• Elena Ituarte
• Kaitlyn Nicole Jackman
• Allison Jackson, LCP
• Leah Jackson
• Sydney Jackson
• Sydney Lynn Jackson
• Sue Jacobson, LAC
• Kelsi Gail Jamerson, FNP
• James I Chou DDS PA

• Mental Health Counselor in Shawnee, KS
• Providers in Shawnee, KS by specialty
• Mental Health Counselor in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.