MICHAEL JACKSON (NPI# 1053603621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053603621 |
| Entity Type | Individual |
| Full Name | MICHAEL JACKSON |
| Practice Address |
829 Chief Eddie Hoffman Hwy Bethel AK 99559 |
| Mailing Address |
Po Box 528 Bethel AK 99559-0528 |
| Practice Telephone | 9075436107 |
| Practice Fax Number | 9075436159 |
| Mailing Telephone | 9075436107 |
| Mailing Fax Number | 9075436159 |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2011-05-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | DA4442 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295345346 | Michael Frederick Jackson | Massage Therapist | 12702 E 33rd Ct, Spokane Valley, WA 99206-8372 | 2020-08-04 |
| 1295372993 | Michael Jackson | Chiropractor | 5216 Cold Springs Way, Eugene, OR 97405-5213 | 2019-12-02 |
| 1801365382 | Michael Jackson | Durable Medical Equipment & Medical Supplies | 5537b N Glenwood St Ste B, Garden City, ID 83714-1336 | 2018-11-14 |
| 1114441375 | Michael Frank Jackson Jr. | Physical Therapist | 1806 Russell Pkwy Ste 1400, Warner Robins, GA 31088-5781 | 2017-07-31 |
| 1457809931 | Michael Jackson | Counselor | 10001 W. Grand Avenue, Franklin Park, IL 60131 | 2016-09-14 |
| 1639625833 | Michael Jackson | Counselor | 128 Mute Swan Place, Newark, DE 19711 | 2016-08-28 |
| 1467823104 | Michael Jackson | Occupational Therapy Assistant | 1913 N Oakes St Apt D, Tacoma, WA 98406-7527 | 2015-10-07 |
| 1831576651 | Michael Howard Jackson | Family Medicine | 4646 Nw Fielding Road, Topeka, KS 66618 | 2015-04-30 |
| 1063809846 | Michael Jackson | Social Worker | 43518 Champlain Ct, Canton, MI 48188-1711 | 2015-04-20 |
| 1780922872 | Michael A Jackson | Pharmacist | 585 Mcwilliams Rd Se Unit 2303, Atlanta, GA 30315-7571 | 2013-01-23 |
| Street Address |
829 CHIEF EDDIE HOFFMAN HWY |
| City | BETHEL |
| State | AK |
| Zip Code | 99559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679542484 | Peter Robert Hergenroether | Counselor | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559 | 2006-03-15 |
| 1376142174 | Thomasina Tishina Smith | Community Health Worker | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0528 | 2020-10-22 |
| 1508478751 | Moses K Ayagalria Jr. | Counselor | 829 Chief Eddie Hoffman Hwy, Suite 150, Bethel, AK 99559-0528 | 2020-08-19 |
| 1720699044 | Reanna Jimmy | Community Health Worker | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0528 | 2020-08-11 |
| 1891306387 | David Mochin | Counselor | 829 Chief Eddie Hoffman Hwy, Suite 150, Bethel, AK 99559-0528 | 2020-08-10 |
| 1396355053 | Lucy Ann Mochin | Counselor | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0528 | 2020-08-06 |
| 1467074518 | Tawanda Moses | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559 | 2020-05-12 |
| 1922635101 | Alice Lucy Leinberger | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hwy, Suite 327, Bethel, AK 99559-0528 | 2020-03-26 |
| 1700413663 | Erica Kameroff | Community Health Worker | 829 Chief Eddie Hoffman Hwy, Suite 150, Bethel, AK 99559-0528 | 2020-03-23 |
| 1386283356 | D'angela Yvette Nickerson | Counselor | 829 Chief Eddie Hoffman Hwy, Suite 150, Bethel, AK 99559-0528 | 2019-12-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194337519 | Michael P Nicolai | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hey, Bethel, AK 99559 | 2020-08-18 |
| 1003438508 | Enc Physical Therapy LLC | Physical Therapist | 223 Blackberry Street, Unit A, Bethel, AK 99559 | 2020-05-07 |
| 1780229609 | Laline Knox | Massage Therapist | 107 Alex Hatley Ste 1, Bethel, AK 99559 | 2019-11-14 |
| 1659920502 | Ana Celina Sebastian | Counselor | 1380 Calista Dr, Bethel, AK 99559 | 2019-09-04 |
| 1639730484 | Jerri Linda Moran-gentle | Massage Therapist | 430 A 7th Ave, Bethel, AK 99559 | 2019-06-24 |
| 1528625381 | Jennifer Peeks | Social Worker | 631 4th Ave. & Main St., Bethel, AK 99559 | 2019-05-28 |
| 1710451190 | Mary Theresa Thibeault | Registered Nurse | Bethel Public Health Center, 1490 Eddie Hoffman Highway, Bethel, AK 99559 | 2019-01-18 |
| 1659846210 | Freda Lizann Jimmie | Counselor | 829 Eddie Hoffman Highway, Bethel, AK 99559 | 2018-10-10 |
| 1073093977 | Romeo Mullai | Counselor | 1630 Calista Drive, Bethel, AK 99559 | 2018-08-20 |
| 1235623794 | Brian Justin Moses | Day Training/Habilitation Specialist | 841 Chief Eddie Hoffman Highway, Bethel, AK 99559 | 2018-06-19 |
| Find all providers in zip 99559 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790395218 | Julia Rodriguez | Counselor | 1410 Calista Drve, Bethel, AK 99559-0528 | 2020-08-10 |
| 1659920502 | Ana Celina Sebastian | Counselor | 1380 Calista Dr, Bethel, AK 99559 | 2019-09-04 |
| 1861048134 | Benjamin Agimuk | Counselor | 5016 Noel Polty, Bethel, AK 99559-1029 | 2019-08-13 |
| 1659846210 | Freda Lizann Jimmie | Counselor | 829 Eddie Hoffman Highway, Bethel, AK 99559 | 2018-10-10 |
| 1073093977 | Romeo Mullai | Counselor | 1630 Calista Drive, Bethel, AK 99559 | 2018-08-20 |
| 1568978799 | Shane Michael Polk | Counselor | 841 State Hwy, Bethel, AK 99559 | 2017-12-26 |
| 1568975357 | Carl Williams | Counselor | 833 Chieff Eddie Hoffman Hwy, Bethel, AK 99559 | 2017-11-15 |
| 1144746330 | Katelynn Rachele Greenwood | Counselor | 1360 Trestal Dr, Bethel, AK 99559 | 2017-08-18 |
| 1346770146 | Kimi Yatsushiro | Counselor | 829 Chief Eddie Hoffman Hightway, Bethel, AK 99559 | 2017-06-14 |
| 1144761677 | Sabrina Mignerey | Counselor | 4042 Oakland Rd, Bethel, OH 45106-8622 | 2017-03-16 |
| Find all providers in BETHEL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.