Kristen Marie Jackson, MA, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC02553 Issued in MN

Practice address

16180 Hastings Ave SE Ste 205
Prior Lake, MN 55372-9228

Phone

(952) 443-4600

Fax

(952) 443-4604

NPI assigned

Apr 12, 2021

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16506/brand/1/csg/1/fhir/r4

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.

• Lorenz Clinic, LLC

  • Marriage & Family Therapist
  • Victoria, MN
  • NPI 1982900510
  NPD
• Youable Emotional Health Services

  • Community/Behavioral Health Agency
  • Richfield, MN
  • NPI 1386728228
  NPD

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

{
    "created_epoch": "1618185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1992385272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51",
            "city": "VICTORIA",
            "state": "MN",
            "postal_code": "553860051",
            "telephone_number": "952-443-4600",
            "fax_number": "952-443-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16180 HASTINGS AVE SE STE 205",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729228",
            "telephone_number": "952-443-4600",
            "fax_number": "952-443-4604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5910 Shingle Creek Pkwy",
            "address_purpose": "LOCATION",
            "city": "Brooklyn Center",
            "state": "MN",
            "postal_code": "554302322",
            "country_code": "US",
            "telephone_number": "763-569-5228",
            "fax_number": "763-569-5240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1435 White Oak Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Chaska",
            "state": "MN",
            "postal_code": "553182567",
            "country_code": "US",
            "telephone_number": "952-443-4600",
            "fax_number": "952-443-4604",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1772 Stieger Lake Ln Ste 220",
            "address_purpose": "LOCATION",
            "city": "Victoria",
            "state": "MN",
            "postal_code": "553867723",
            "country_code": "US",
            "telephone_number": "952-443-4600",
            "fax_number": "952-443-4604",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15265 Carrousel Way Ste 100",
            "address_purpose": "LOCATION",
            "city": "Rosemount",
            "state": "MN",
            "postal_code": "550681760",
            "country_code": "US",
            "telephone_number": "952-443-4600",
            "fax_number": "952-443-4604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-12",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC02553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridget Nicole Holbrook, PA-C
• Todd H Holm, M.D.
• Katherine Ann Huntington, PA
• Doreen Lubi Isubikalu
• Jolyn Rae Jaberi, D.D.S.
• Allen Jerome Johnson
• Kathryn Lynn Jonsrud, R.PH
• Charles Howard Jorenby, MA, LP
• Zachary Thomas Kahmeyer, M.A., LPCC
• Kala Counseling Services

• Professional Counselor in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.