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DR. CHARLES WESLEY JACKSON PH D NPI 1437224813


NPI Information

NPI: 1437224813
Provider Name: DR. CHARLES WESLEY JACKSON, PH D
Classification: Psychologist - 103TC0700X
Entity Type: Individual

Specialization: Clinical

PECOS Registration: Yes

Address:
2980 WASHINGTON BLVD
CLEVELAND HEIGHTS, OH
ZIP 44118
Phone: (216) 321-9355
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DR. Charles Wesley Jackson, PH D is a clinical psychologist in Cleveland Heights, OH. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. DR. Charles Wesley Jackson, PH D NPI is 1437224813. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2980 WASHINGTON BLVD
CLEVELAND HEIGHTS, OH
ZIP 44118-450
Phone: (216) 321-9355
Fax: (216) 932-3341

The NPI 1437224813 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 11/21/2006 and was last updated on 10/8/2012.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TC0700XPsychologistClinicalPSYCHOLOGIST 000519MICHIGANNo
2103TC0700XPsychologistClinicalPSYCHOLOGIST 474OHIOYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1CP09651MEDICARE ID-TYPE UNSPECIFIED
2CP34291MEDICARE PINOHIO
30253309MEDICAIDOHIO

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.