SHANE MICHELL JACKSON LPC NPI 1922173897

NPI Information

NPI: 1922173897
Provider Name: SHANE MICHELL JACKSON, LPC
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
115 W TYLER ST
GILMER, TX
ZIP 75644
Phone: (903) 746-7643
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Shane Michell Jackson, LPC is an addiction (substance use disorder) counselor in Gilmer, TX. Shane Michell Jackson, LPC NPI is 1922173897. 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:

115 W TYLER ST
GILMER, TX
ZIP 75644-239
Phone: (903) 746-7643
Fax: (903) 843-4336

The enumeration date for this NPI number is 11/22/2006 and was last updated on 7/8/2007.

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	101YA0400X	Counselor	Addiction (Substance Use Disorder)	4128	TEXAS	Yes
2	101YM0800X	Counselor	Mental Health	16480	TEXAS	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	4128	OTHER	TEXAS	LCDC
2	16480	OTHER	TEXAS	LPC

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: 5/5/2024

NPI Synchronization or Removal

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