SHANE MICHELL JACKSON LPC NPI 1922173897

NPI Information

  • NPI: 1922173897
  • Provider Name: SHANE MICHELL JACKSON, LPC
  • Classification: Counselor - 101YA0400X
  • Specialization: Addiction (Substance Use Disorder)
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 115 W TYLER ST
    GILMER, TX
    ZIP 75644
  • Phone: (903) 746-7643

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NPI Details

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 NPI 1922173897 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 11/22/2006 and was last updated on 9/11/2025.

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
1101YA0400XCounselorAddiction (Substance Use Disorder)4128TEXASYes
2101YM0800XCounselorMental Health16480TEXASNo

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
116480OTHERTEXASLPC
24128OTHERTEXASLCDC

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: 11/21/2025

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