SAM JACKSON (NPI# 1851750061) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851750061 |
| Entity Type | Individual |
| Full Name | SAM JACKSON |
| Credential | LAC |
| Practice Address |
4250 E Florian Ave Building #1 Mesa AZ 85206-2797 |
| Mailing Address |
924 N Country Club Dr Building #1 Mesa AZ 85201-4108 |
| Practice Telephone | 4808441653 |
| Mailing Telephone | 4809693800 |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2016-02-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | LAC-15314 | AZ | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083812366 | Sam Jackson | Emergency Medicine | 925 E Mcdowell Rd, Floor 2, Phoenix, AZ 85006-2502 | 2007-07-06 |
| Street Address |
4250 E FLORIAN AVE BUILDING #1 |
| City | MESA |
| State | AZ |
| Zip Code | 85206-2797 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619912029 | Marc Community Resources, Inc. | Clinic/Center | 4250 E Florian Ave, Building 1, Mesa, AZ 85206 | 2006-06-19 |
| 1134774417 | Dennis Ray | Behavior Technician | 4250 E Florian Ave, Building 1 & 2, Mesa, AZ 85206 | 2019-08-05 |
| 1770041386 | Cecillie Nakai | Behavior Technician | 4250 E Florian Ave, Mesa, AZ 85206-2797 | 2019-03-04 |
| 1306344908 | Laura Norfor | Behavior Technician | 4250 E Florian Ave, Mesa, AZ 85206-2797 | 2018-01-29 |
| 1922544337 | Christa Crohurst | Counselor | 4250 E Florian Ave, Building #1, Mesa, AZ 85206-2797 | 2017-01-09 |
| 1285189019 | Tonia Halona | Technician, Other | 4250 E Florian Ave, Building #1, Mesa, AZ 85206-2797 | 2016-08-22 |
| 1174993984 | Benjamin Salicco | Technician, Other | 4250 E Florian Ave, Building #1, Mesa, AZ 85206-2797 | 2015-10-06 |
| 1063891638 | Brett Petersen | Social Worker | 4250 E Florian Ave, Building #1, Mesa, AZ 85206-2797 | 2015-05-28 |
| 1982016432 | Jennifer Kizer | Counselor | 4250 E Florian Ave, Building #1, Mesa, AZ 85206-2797 | 2014-06-02 |
| 1407284201 | Danielle Chinavare | Counselor | 4250 E Florian Ave, Bldg 1, Mesa, AZ 85206-2797 | 2013-10-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720693062 | Inner Balance Counseling LLC | Counselor | 4111 E Auto Valley Drive, Suite 101, Mesa, AZ 85206 | 2020-09-14 |
| 1356978969 | Choices 4 Change Counseling and Coaching LLC | Social Worker | 3707 E Southern Ave., Suite 2027, Mesa, AZ 85206 | 2020-03-24 |
| 1023651288 | Jason Mcclure | Hearing Instrument Specialist | 5540 E Broadway Rd., Mesa, AZ 85206 | 2019-10-21 |
| 1255995361 | Vhs of Phoenix Inc | General Acute Care Hospital | 5750 E. Baseline Rd., Mesa, AZ 85206 | 2019-04-24 |
| 1932682184 | Adam Fishel Frose | Psychologist | 4555 E Inverness Ave Ste 112, Mesa, AZ 85206 | 2018-09-13 |
| 1376024737 | Robyn Kathleen Hall | Psychologist | 4115 East Valley Auto Drive, Suite 208, Mesa, AZ 85206 | 2018-08-23 |
| 1790264984 | Perspective Health, LLC | Clinic/Center | 1959 S. Power Rd, Suite 103, #206, Mesa, AZ 85206 | 2018-08-09 |
| 1033605159 | Rebecca Ann Maro | Nurse Practitioner | 6750 E Baywood Ave Ste 502, Mesa, AZ 85206 | 2018-07-02 |
| 1982195624 | Spark Performance and Physiotherapy | Clinic/Center | 6056 East Basline Road, Suite 147, Mesa, AZ 85206 | 2018-05-29 |
| 1336645993 | Ashley Wright | Audiologist-Hearing Aid Fitter | 1423 S Higley Rd Ste 119, Mesa, AZ 85206 | 2018-04-03 |
| Find all providers in zip 85206 | ||||
| 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 |
|---|---|---|---|---|
| 1801414164 | Rosalie Marie Hasseltine | Counselor | 44 S Greenfield Rd Unit 9, Mesa, AZ 85206-1210 | 2020-07-13 |
| 1811552581 | Samuel Paul Bryant | Counselor | 1024 W Fremont Ave, Mesa, AZ 85210-9316 | 2019-05-07 |
| 1326511593 | Smith Behavioral Health, P.C. | Counselor | 225 W 1st St Unit 120, Mesa, AZ 85201-6554 | 2019-01-09 |
| 1013496751 | Renee Christine Deyden | Counselor | 533 W Guadalupe Rd Unit 1073, Mesa, AZ 85210-7761 | 2018-08-13 |
| 1245720663 | Kristian Jay Mastin | Counselor | 2345 S Alma School Rd Ste 102, Mesa, AZ 85210-4013 | 2018-05-10 |
| 1477055176 | Erik Adair Johnson | Counselor | 6262 E Broadway Rd Ste 110, Mesa, AZ 85206-6101 | 2018-03-08 |
| 1023510435 | Denise M Bruno-krupp | Counselor | 1830 S. Alma School Rd. Suite 101, Mesa, AZ 85210 | 2018-03-01 |
| 1679090369 | Jessica L Sisson | Counselor | 8844 E Pampa Ave, Mesa, AZ 85212-2829 | 2017-08-24 |
| 1417489162 | Emily Kirkland | Counselor | 2204 S Dobson Rd Ste 102, Mesa, AZ 85202-6457 | 2017-03-31 |
| 1609314434 | Jared Mcgrath | Counselor | 5345 E Mclellan Rd, Unit 53, Mesa, AZ 85205-3412 | 2017-01-31 |
| Find all providers in MESA | ||||
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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.