Rickey T. Jackson, PSY. S.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Practice address

20600 Eureka Rd
Suite 819
Taylor, MI 48180-5343

Phone

(734) 285-8282

NPI assigned

Jul 14, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: lifestancehealth.rickeyjackson@150339.advancedmd-direct.com

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1962428748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17360 BIRCHCREST DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212733",
            "telephone_number": "313-861-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20600 EUREKA RD",
            "address_2": "SUITE 819",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481805343",
            "telephone_number": "734-285-8282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RICKEY",
        "middle_name": "T.",
        "name_prefix": "Prof.",
        "credential": "PSY. S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301008412",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taha F Issa
• Angel Izuagbe
• Faten A Jaafar
• Serena Jaber
• Helen Louise Jackson, PSYD, LLP
• Umakanth Reddy Jagu
• Lani Jakovac, OTRL
• Linda Jakubus
• Nergis Jassim
• Meredith Jeffrey, O.D.

• Clinical Child & Adolescent Psychologist in Taylor, MI
• Providers in Taylor, MI by specialty
• Clinical Child & Adolescent Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.