CRYSTAL A. JACKSON, PH.D. , LLP, LLC (NPI# 1073124772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073124772 |
| Entity Type | Organization |
| Organization Name | CRYSTAL A. JACKSON, PH.D. , LLP, LLC |
| Other Organization Name | CRYSTAL A. JACKSON, PH.D. , LLP, LLC |
| Practice Address |
3011 W Grand Blvd Detroit MI 48202-3096 |
| Mailing Address |
3011 W Grand Blvd Ste 413 Detroit MI 48202-3011 |
| Practice Telephone | 5869430563 |
| Mailing Telephone | 5869430563 |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2020-10-19 |
| Authorized Official Name | DR. CRYSTAL A JACKSON (OWNER/PSYCHOLOGIST) |
| Authorized Official Telephone | 5869430563 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Crystal A. Jackson, Ph.D. , LLP, LLC | Doing Business As Name - Organization |
| Street Address |
3011 W GRAND BLVD |
| City | DETROIT |
| State | MI |
| Zip Code | 48202-3096 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518956259 | Debra Ann Brodie | Psychologist | 3011 W Grand Blvd, Suite 418, Detroit, MI 48202-3096 | 2005-10-16 |
| 1841707023 | Gospel Against Aids Inc | Community Health Worker | 3011 W Grand Blvd, Detroit, MI 48202-3096 | 2018-01-09 |
| 1033654595 | Tri-state Physicians Group PC | Emergency Medicine | 3011 W Grand Blvd, Suite 306, Detroit, MI 48202-3096 | 2016-12-19 |
| 1316482870 | New Center Medical PC | Emergency Medicine | 3011 W Grand Blvd, Suite 308, Detroit, MI 48202-3096 | 2016-12-19 |
| 1861934168 | Natlab Inc | Clinical Medical Laboratory | 3011 W Grand Blvd, Suite 309, Detroit, MI 48202-3096 | 2016-11-17 |
| 1427501733 | Detroit Public Schools Community District | Local Education Agency (LEA) | 3011 W Grand Blvd, 11th Floor Fisher Building, Detroit, MI 48202-3096 | 2016-08-03 |
| 1518326610 | Gabriel Williams Dds PC | Dentist | 3011 W Grand Blvd, Suite 867, Detroit, MI 48202-3096 | 2016-02-17 |
| 1649645284 | Tcw Surgical Center LLC | Clinic/Center | 3011 W Grand Blvd, Suite 305, Detroit, MI 48202-3096 | 2015-12-08 |
| 1720469893 | Suprene Home Care Givers Agency LLC | Home Health | 3011 W Grand Blvd, 858, Detroit, MI 48202-3096 | 2015-06-15 |
| 1275925950 | Health Pro LLC | Pharmacy | 3011 W Grand Blvd, Suite 300, Detroit, MI 48202-3096 | 2015-03-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710584602 | Andrea Irene Martin | Audiologist | 2799 E Grand Blvd, Detroit, MI 48202 | 2020-10-05 |
| 1174132583 | Odei Alayyas | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Boulevard Henry Ford Hospital, Medical Ed, Detroit, MI 48202 | 2020-07-31 |
| 1912529801 | Aroob Nabil Nimer Sweidan | Student in an Organized Health Care Education/Training Program | 2799 West Grand Boulvard, Department of Internal Meidicine, Cfp 1, Detroit, MI 48202 | 2020-05-13 |
| 1306485636 | Katie Burlen-davis | Registered Nurse | 9045 Woodward Ave, Detroit, MI 48202 | 2020-01-03 |
| 1407401250 | Santhalakshmi Angappan | Student in an Organized Health Care Education/Training Program | Henry Ford Hospital Medical Education Department, 2799 W. Grand Boulevard, Detroit, MI 48202 | 2019-08-08 |
| 1851945687 | Walter Mitini Etoh | Nurse Practitioner | Henry Ford Hospital I1 Observation, 2799 W. Grand Blvd, Detroit, MI 48202 | 2019-07-30 |
| 1467913756 | Andrew Michael Schock | Emergency Medicine | Ceci Murrell-harvey, Henry Ford Hospital, 2799 W. Grand. Blvd, Cfp 046, Detroit, MI 48202 | 2019-03-28 |
| 1700363892 | Zaid Al-saheli | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvdl, Cfp 046, Hope Peck, Detroit, MI 48202 | 2018-07-23 |
| 1932690096 | Yusuf Naser Alalwan | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvd. Henry Ford Hospital - Gme Office, Detroit, MI 48202 | 2018-05-24 |
| 1568952729 | Kelvin Sellers | Massage Therapist | 832 Seward, Detriot, MI 48202 | 2018-05-14 |
| Find all providers in zip 48202 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285129221 | Wayne State University | Psychologist | 540 E Canfield St Ste 1241, Detroit, MI 48201 | 2018-06-22 |
| 1508362922 | Claudia Anagurthi | Psychologist | Chm/specilty Center, 3950 Beaubien Ground Fl, Detroit, MI 48201 | 2018-04-04 |
| 1992136295 | Marilyn Franklin | Psychologist | 9000 E Jefferson Ave Apt 28-17, Detroit, MI 48214-2940 | 2013-12-12 |
| 1144669318 | Julia Helene Bellamy | Psychologist | 3901 Chrysler Dr Ste 3b, Detroit, MI 48201-2167 | 2013-06-20 |
| 1255675005 | Nicole Henriksen | Psychologist | 4201 Saint Antoine St Ste 4b, Detroit, MI 48201 | 2012-11-17 |
| 1093061517 | Kinneta Easter Mason | Psychologist | 19738 Fielding St, Detroit, MI 48219 | 2012-08-02 |
| 1376859785 | Eugene Ronald Craig | Psychologist | 300 Riverfront Dr, Suite 16 H, Detroit, MI 48226-4516 | 2010-08-23 |
| 1902126725 | Dana Raquel Lasenby | Psychologist | 3434 Russell St, Suite #307, Detroit, MI 48207-2062 | 2010-06-03 |
| 1699004614 | Monica Anne Moore | Psychologist | 18940 Oak Dr, Detroit, MI 48221-2264 | 2009-12-22 |
| 1750610796 | Sekai Denard Broaden | Psychologist | 14952 Rosemont Ave, Detroit, MI 48223-2364 | 2009-12-22 |
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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.