MS. MARY ELISABETH JACKSON (NPI# 1437456522) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437456522 |
| Entity Type | Individual |
| Full Name | MS. MARY ELISABETH JACKSON |
| Credential | LCPC |
| Practice Address |
804 South Oakland Ave Carbondale IN 62901 |
| Mailing Address |
804 S Oakland Ave Carbondale IL 62901-2555 |
| Practice Telephone | 6182033975 |
| Practice Fax Number | 6185292182 |
| Mailing Telephone | 6182033975 |
| Mailing Fax Number | 6185292182 |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2011-02-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 180.007729 | IL | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922605690 | Mary Sonya Jackson | Contractor | 5480 Hedge Brooke Pointe Nw, Acworth, GA 30101-7142 | 2020-10-06 |
| 1194388678 | Mary Sheree Jackson | Home Health Aide | 226 Mckinley St, Pittsburgh, PA 15210-3312 | 2019-04-19 |
| 1508358813 | Mary Jackson | Counselor | 3442 W Emma Pl, Queen Creek, AZ 85142-0506 | 2018-06-01 |
| 1891220935 | Mary Jackson | Counselor | 2824 N Cascade Ave, Colorado Springs, CO 80907-6213 | 2017-04-26 |
| 1992152672 | Mary Jackson | Non-emergency Medical Transport (VAN) | 421 Lively Hope Rd, Callao, VA 22435-2511 | 2016-05-23 |
| 1699121129 | Mary Theresa Jackson | Counselor | 345 Old Cuyler Rd, Ellabell, GA 31308-5858 | 2016-05-13 |
| 1013331586 | Mary Jackson I | Chore Provider | 555 Old Lewiston Rd, Winthrop, ME 04364-4112 | 2014-02-04 |
| 1316203854 | Mary Louise Jackson | Home Health Aide | 256 Clairmont Ave, Mansfield, OH 44903-1547 | 2012-04-10 |
| 1376835298 | Mary Bickel Jackson | Nutritionist | 33 Fulton Plaza, Middletown, NY 10940 | 2011-05-11 |
| 1700186707 | Mary Sebrena Jackson | Social Worker | 450 Racetrack Rd, Mcdonough, GA 30252-6837 | 2010-10-25 |
| Street Address |
804 SOUTH OAKLAND AVE |
| City | CARBONDALE |
| State | IN |
| Zip Code | 62901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| 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 |
|---|---|---|---|---|
| 1831716844 | Valerie Newton | Counselor | 200 N Emerald Ln Ste 3, Carbondale, IL 62901-2170 | 2020-06-26 |
| 1235761784 | Ashley Ettinger | Counselor | 38 North Scott Road, Carbondale, PA 18407 | 2020-02-12 |
| 1356621528 | John Cosmo Obell | Counselor | 6 N Church St, St. Rose Rectory, Carbondale, PA 18407-2393 | 2011-08-19 |
| 1124299706 | Bonnie M Henry | Counselor | 602 S Wedgewood Ln, Carbondale, IL 62901-2119 | 2008-03-21 |
| 1699376517 | Taylor Holloway | Counselor | 200 N Emerald Ln Ste 3, Carbondale, IL 62901-2170 | 2020-11-06 |
| 1861009128 | Ashley Pruett | Counselor | 2311 S Illinois Ave, Carbondale, IL 62903-5912 | 2020-09-30 |
| 1477167823 | Zachary Woosley | Counselor | 2311 S Illinois Ave, Carbondale, IL 62903-5912 | 2020-09-03 |
| 1225648652 | Trisha Fuller | Counselor | 200 N Emerald Ln, Carbondale, IL 62901-2159 | 2020-07-31 |
| 1043829450 | Chelsea Oschs | Counselor | 200 N Emerald Ln, Carbondale, IL 62901-2159 | 2020-07-31 |
| 1427667161 | Brandy Moore | Counselor | 200 N Emerald Ln, Carbondale, IL 62901-2159 | 2020-07-29 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
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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.