JACKSON THERAPY
NPI 1164080693
Social Worker - Clinical in Urbana, IL

Q: What is Jackson Therapy's NPI number?

The NPI number for Jackson Therapy is 1164080693. It was assigned to this organization in the NPPES registry on May 30, 2019.

Q: What is Jackson Therapy's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Jackson Therapy was last updated on March 30, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since May 30, 2019

404 W GREEN ST, URBANA, IL 61801(217) 706-5498(217) 706-5779 Get Directions Write a Review

NPPES record last updated: March 30, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 30, 2023, Jun 4, 2019, May 30, 2019 (3 updates tracked since 2019).

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About Jackson Therapy NPPES

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

JACKSON THERAPY (NPI 1164080693) is a healthcare organization registered as a clinical in Urbana, Illinois and active in the NPI registry since May 2019. The organization lists Angela Jackson, Owner/lead Therapist, as its authorized official.

NPPES Registry Identity

NPI1164080693

Entity TypeOrganization

Primary Taxonomy1041C0700X

Legal Business NameJACKSON THERAPY

Location Address404 W GREEN STUrbana, IL 61801-3267

Mailing Address230 W Main StDecatur, IL 62523-1215 · (217) 706-5498

Phone(217) 706-5498

Fax(217) 706-5779

Organization SubpartNo

Authorized OfficialAngela JacksonOwner/lead Therapist · (217) 840-4090

Enumeration DateMay 30, 2019

Last NPPES UpdateMarch 30, 20233 updates tracked since enumeration

NPPES CertifiedMarch 30, 2023

✔ NPI 1164080693 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

404 W GREEN ST, Urbana, IL 61801

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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

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHRISTOPHER LAWRENCE MENARD PSY.D.

Psychologist (Clinical)