MR. TRACEY L JACKSON (NPI# 1558486803) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558486803 |
| Entity Type | Individual |
| Full Name | MR. TRACEY L JACKSON |
| Practice Address |
4612 Roosevelt Ave Sacramento CA 95820 |
| Mailing Address |
4612 Roosevelt Ave Sacramento CA 95820-4520 |
| Practice Telephone | 9164573129 |
| Mailing Telephone | 9164573129 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2019-01-11 |
| 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 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7000 Franklin Blvd Ste 200, Sacramento, CA 958231865 | 9163940800 | 9164297824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134571730 | Tracey Francine Jackson | Technician, Other | 22764 Normandy Ave, Eastpointe, MI 48021-1854 | 2016-07-07 |
| 1639532765 | Tracey Jackson | Social Worker | 5937 Larchwood Ave, Philadelphia, PA 19143-1115 | 2016-04-05 |
| 1609063882 | Tracey Monique Jackson | Registered Nurse | 23 Flanders St, Rochester, NY 14619-1705 | 2007-10-01 |
| 1174948038 | Tracey Jackson | Occupational Therapist | 4801 Springfield St, Dayton, OH 45431-1084 | 2014-02-28 |
| 1255755930 | Tracey Jackson | Case Manager/Care Coordinator | 820 N Plankinton Ave, Milwaukee, WI 53203-1802 | 2014-02-14 |
| 1861643389 | Tracey Ann Jackson | Counselor | 1547 Parkway Ste 100, Greenwood, SC 29646-4081 | 2008-10-02 |
| 1487803870 | Tracey D Jackson | Pharmacist | 1000 Locust St, Reno, NV 89502-2597 | 2008-09-10 |
| 1902074545 | Tracey Jackson | Counselor | 2814 W 2nd St, Wilmington, DE 19805-1807 | 2008-02-18 |
| 1215121835 | Tracey Jackson | Physician Assistant | 320 E North Ave, Pittsburgh, PA 15212-4756 | 2007-08-28 |
| 1902808868 | Tracey L Jackson | Nurse Anesthetist, Certified Registered | 615 S New Ballas Rd, Sjmmc Dept of Anes, Saint Louis, MO 63141-8221 | 2005-08-11 |
| Street Address |
4612 ROOSEVELT AVE |
| City | SACRAMENTO |
| State | CA |
| Zip Code | 95820 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265455893 | Melissa Vanteslaar | Marriage & Family Therapist | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2006-07-25 |
| 1497362057 | Liana Loren Perez | Licensed Vocational Nurse | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2020-09-28 |
| 1811502040 | Maddysen Casimir-taylor | Counselor | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2020-09-14 |
| 1316557465 | Bintu Sia Sorie | Licensed Psychiatric Technician | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2020-08-04 |
| 1770101735 | Sheryll Pragasa | Counselor | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2020-07-07 |
| 1326679812 | Tia Dalipe | Technician, Pathology | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2020-02-03 |
| 1962062844 | Ashley A Vicens | Licensed Vocational Nurse | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2019-06-13 |
| 1699258392 | Odubanke Yewande Mcgaugh | Licensed Psychiatric Technician | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2018-09-10 |
| 1528553062 | Allen Christopher Mendoza | Licensed Vocational Nurse | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2018-06-27 |
| 1558854158 | Laura Jeanne Bishop | Counselor | 4612 Roosevelt Ave, Sacramento, CA 95820-4520 | 2018-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629676820 | Laraine K Koen | Student in an Organized Health Care Education/Training Program | 123 Brookshire Lane, Sacramento, CA 95820 | 2020-10-12 |
| 1730737727 | Vincent Tang | Student in an Organized Health Care Education/Training Program | 3230 Sher Court, Sacramento, CA 95820 | 2019-09-03 |
| 1871159897 | Lauren Smith | Student in an Organized Health Care Education/Training Program | Department of Pediatrics Uc Davis Children's Hospital, 3671 Business Dr. Suite #110, Sacramento, CA 95820 | 2019-05-15 |
| 1053899336 | Melissa Anne Jeffery | Community Health Worker | 4600 Broadway Suite 1300, Sacramento, CA 95820 | 2018-07-30 |
| 1841785284 | Chelsea Kirstin Acker | Student in an Organized Health Care Education/Training Program | 3671 Business Dr., Sacramento, CA 95820 | 2018-06-28 |
| 1770022667 | Shelly Valdez | Behavior Technician | 5520 Priscilla Ln, Sacramento, CA 95820 | 2017-02-13 |
| 1285184135 | Trang Thu Tran | Registered Nurse | 5385 Franklin Blvd Ste A-d, Sacramento, CA 95820 | 2016-10-04 |
| 1356716039 | Nicole Hisaka | Psychologist | 3651 Business Dr, Sacramento, CA 95820 | 2015-12-07 |
| 1538542469 | Universal Med Express, LLC | Non-emergency Medical Transport (VAN) | 3230 27th Ave, Sacramento, CA 95820 | 2015-07-09 |
| 1033507470 | Moua Yang | Case Manager/Care Coordinator | 7373 14th Ave, Suite 120-b, Sacramento, CA 95820 | 2015-01-08 |
| Find all providers in zip 95820 | ||||
| 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 |
|---|---|---|---|---|
| 1952909210 | Christopher Shirey | Counselor | 1618 Alhambra Blvd, Sacramento, CA 95816-7601 | 2020-10-09 |
| 1043824337 | Adonis R Johnson | Counselor | 2500 Marconi Ave, Sacramento, CA 95821-4853 | 2020-09-03 |
| 1528676160 | Hope Lynn Mulligan | Counselor | 2750 Sutterville Rd # Cottage1, Sacramento, CA 95820-1024 | 2020-07-20 |
| 1235756891 | Guneet Kaur | Counselor | 8247 E Stockton Blvd # 4, Sacramento, CA 95828-8200 | 2020-06-30 |
| 1073132635 | Gage Michael Smith | Counselor | 7055 Woodrick Way, Sacramento, CA 95842-2246 | 2020-04-14 |
| 1952935876 | Crystal S Nicholas | Counselor | 845 Fulton Ave Apt 1051, Sacramento, CA 95825-6434 | 2020-02-29 |
| 1255975827 | Molly Ritter | Counselor | 650 Bercut Dr Ste C, Sacramento, CA 95811-0100 | 2019-11-06 |
| 1396393823 | Lannon Hope Gustafson | Counselor | 8573 E Southgate Dr., Sacramento, CA 95823 | 2019-08-28 |
| 1821642265 | Courtney Nelson | Counselor | 7818 Bardu Ln, Sacramento, CA 95829 | 2019-07-24 |
| 1669948212 | Micaela Badue | Counselor | 401 S St., Sacramento, CA 95811 | 2018-10-22 |
| Find all providers in SACRAMENTO | ||||
| City | SACRAMENTO |
| Zip Code | 95820 |
Please comment or provide details below to improve the information on MR. TRACEY L JACKSON.
| 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.