MRS. SANDRA JACKSON LMHC NPI 1356330765

NPI Information

NPI: 1356330765
Provider Name: MRS. SANDRA JACKSON, LMHC
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

PECOS Registration: Yes

Address:
1955 US HIGHWAY 1 S
SUITE C-2
ST AUGUSTINE, FL
ZIP 32086
Phone: (904) 209-6222
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MRS. Sandra Jackson, LMHC is a mental health counselor in St Augustine, FL. MRS. Sandra Jackson, LMHC NPI is 1356330765. 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:

1955 US HIGHWAY 1 S
SUITE C-2
ST AUGUSTINE, FL
ZIP 32086-708
Phone: (904) 209-6222
Fax: (904) 209-6291

The NPI 1356330765 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 10/18/2005 and was last updated on 7/24/2012.

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	101Y00000X	Counselor		MH8391	FLORIDA	No
2	101YM0800X	Counselor	Mental Health	MH8391	FLORIDA	Yes

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	767122900	MEDICAID	FLORIDA
2	Z089A	OTHER	FLORIDA	BCBS

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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