PHOENIX JACKSON NPI 1619349933

NPI Information

NPI: 1619349933
Provider Name: PHOENIX JACKSON
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
1 SAINT VINCENTS DR
SAN RAFAEL, CA
ZIP 94903
Phone: (415) 610-1768
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Phoenix Jackson is a mental health counselor in San Rafael, CA. Phoenix Jackson NPI is 1619349933. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1 SAINT VINCENTS DR
SAN RAFAEL, CA
ZIP 94903-504
Phone: (415) 610-1768

The enumeration date for this NPI number is 10/26/2015 and was last updated on 10/25/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	106H00000X	Marriage & Family Therapist		91873	CALIFORNIA	No
2	101Y00000X	Counselor				No
3	101YS0200X	Counselor	School			No
4	390200000X	Student in an Organized Health Care Education/Training Program		91873	CALIFORNIA	No
5	101YM0800X	Counselor	Mental Health	91873	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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