JEAN PETRILLA JACKSON (NPI# 1710048830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710048830 |
| Entity Type | Individual |
| Full Name | JEAN PETRILLA JACKSON |
| Credential | MA, LPC |
| Practice Address |
855 Central Dr Odessa TX 79761-4200 |
| Mailing Address |
1200 W 10th St Odessa TX 79763-3546 |
| Practice Telephone | 4325807250 |
| Practice Fax Number | 4325822020 |
| Mailing Telephone | 4325807250 |
| Mailing Fax Number | 4325822020 |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
14966 | TX | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CIGNA | 1296590 | 01 | |
| TX | BLUECROSS BLUESHIELD | 3710LC | 01 |
| AETNA | 5212693 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346766870 | Jean Ann Jackson | Dietitian, Registered | 401 North Hooper Street, Caro, MI 48723 | 2017-08-16 |
| 1700840162 | Jean Leigh Jackson | Emergency Medicine | 2014 Washington St, Newton, MA 02462 | 2006-04-13 |
| Street Address |
855 CENTRAL DR |
| City | ODESSA |
| State | TX |
| Zip Code | 79761-4200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447674478 | Rachel Hurford | Counselor | 855 Central Dr, Odessa, TX 79761-4200 | 2014-02-11 |
| 1669748000 | Myrna Russell | Counselor | 855 Central Dr, Suite 15, Odessa, TX 79761-4200 | 2012-03-30 |
| 1508157322 | Misty Locknane | Counselor | 855 Central Dr, Suite 2, Odessa, TX 79761-4200 | 2011-04-27 |
| 1528393162 | Atec Group, LLC | Hearing Instrument Specialist | 855 Central Dr, Suite 16, Odessa, TX 79761-4200 | 2009-10-15 |
| 1407088412 | Tommy Lewis Pool II | Counselor | 855 Central Dr, Suite 8, Odessa, TX 79761-4200 | 2009-08-10 |
| 1295939460 | Sentry Medical Corporation | Physiological Laboratory | 855 Central Dr, Suite 15, Odessa, TX 79761-4200 | 2007-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407482003 | Endovascular Lab Pllc | Surgery | 612 N Washington Avenue, Suite 100, Odessa, TX 79761 | 2020-03-16 |
| 1235627605 | Megan Elizabeth Lemond | Pediatrics | 912 E 5th St, Odessa, TX 79761 | 2018-05-01 |
| 1922522630 | Brian W Griffin | Nurse Practitioner | 4606 Fountain Ln., Odessa, TX 79761 | 2017-08-03 |
| 1023540507 | Florenda De Guzman | Nurse Practitioner | 405 N Tom Green, Odessa, TX 79761 | 2017-04-03 |
| 1205378239 | Scotty R Ortega Md | Clinical Nurse Specialist | 2487 E 11th Street, Odessa, TX 79761 | 2016-11-08 |
| 1487094355 | Marivel Perez | Nurse Practitioner | 540 W 5th St Ste 350, Ste. 350, Odessa, TX 79761 | 2013-06-25 |
| 1245579804 | Accurate Health Care LLC | Home Health | 302 Industrial Ave, Odessa, TX 79761 | 2013-02-01 |
| 1437421666 | Mary Magdalene Garcia | Speech-Language Pathologist | 620 N. Alleghaney, Odessa, TX 79761 | 2012-02-03 |
| 1841576378 | Ashley Burdex | Family Medicine | 6030 W University, Odessa, TX 79761 | 2011-10-28 |
| 1730465428 | Therese A Archer | Massage Therapist | 712 N. Texas Ave, Odessa, TX 79761 | 2011-10-26 |
| Find all providers in zip 79761 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922591692 | Dana D Debose | Counselor | 2301 Conover Ave, Odessa, TX 79763-2112 | 2018-06-07 |
| 1528432283 | Florence Pride | Counselor | 835 Tower Dr Ste 1, Odessa, TX 79761-4251 | 2015-11-18 |
| 1619303922 | Jessica Riley-bolden | Counselor | 1901 E 37th St Ste 209, Odessa, TX 79762-6210 | 2013-09-18 |
| 1629419015 | William Michael Koch | Counselor | 416 East Chestnut Street, Odessa, MO 64076-1580 | 2013-07-12 |
| 1164762977 | Beth Desilets | Counselor | 1901 E 37th St Ste 104, Odessa, TX 79762-6210 | 2013-02-15 |
| 1730499104 | Pamela Joyce Miller | Counselor | 406 A N. 4th Street, Odessa, MO 64076 | 2010-10-19 |
| 1487885711 | Audrey May Steakley | Counselor | 203 Santa Rita Dr, Odessa, TX 79763-2943 | 2009-08-04 |
| 1053541847 | Amy Bryant Garman | Counselor | 3414 Seguin, Odessa, TX 79765-8967 | 2009-07-15 |
| 1003075482 | Charlene Kay Atkins | Counselor | 406a N 4th St Ste A, Odessa, MO 64076-1152 | 2008-06-02 |
| 1578749560 | Darla Jean Avery | Counselor | 2706 N Century Ave, Odessa, TX 79762-7937 | 2008-01-21 |
| Find all providers in ODESSA | ||||
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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.