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ELISSA NACOLE JACKSON RESIDENT ASSISTANT
NPI 1104587401
Counselor - Mental Health in Tulsa, OK

Active since January 07, 2022
1719 E 27TH ST N, TULSA, OK 74110(918) 982-7687 Get Directions Write a Review

NPPES record last updated: January 7, 2022. Verified against the NPPES registry weekly; last sync: September 06, 2026.

About Elissa Nacole Jackson Resident Assistant NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELISSA NACOLE JACKSON RESIDENT ASSISTANT (NPI 1104587401) is an individual mental health provider in Tulsa, Oklahoma and active in the NPI registry since January 2022.

NPPES Registry Identity

NPI1104587401
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameELISSA NACOLE JACKSONCredential: RESIDENT ASSISTANT
Location Address1719 E 27TH ST NTulsa, OK 74110-1705
Mailing Address1719 E 27th St NTulsa, OK 74110-1705 · (918) 982-7687
Phone(918) 982-7687
Sole ProprietorYes
Enumeration DateJanuary 7, 2022
NPPES CertifiedJanuary 7, 2022
✔ NPI 1104587401 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
1719 E 27TH ST N, Tulsa, OK 74110
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Elissa Jackson's NPI number?

The NPI number for Elissa Jackson is 1104587401. It was assigned to this individual provider in the NPPES registry on January 7, 2022.

Where is Elissa Jackson located?

Elissa Jackson practices at 1719 E 27th St N, Tulsa, OK 74110. The listed phone number is (918) 982-7687.

What is Elissa Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Elissa Jackson was last updated on January 7, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.