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STACI LYN JACKSON LMFT
NPI 1174246060
Marriage & Family Therapist in Leicester, MA

Active since September 26, 2022PECOS Enrolled
1136 MAIN ST, LEICESTER, MA 01524(607) 207-6681 Get Directions Write a Review

NPPES record last updated: August 12, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 12, 2025, Sep 26, 2022 (2 updates tracked since 2022).

About Staci Lyn Jackson Lmft NPPES

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

STACI LYN JACKSON LMFT (NPI 1174246060) is an individual marriage & family therapist in Leicester, Massachusetts, licensed in Massachusetts (1836) and active in the NPI registry since September 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2015).

NPPES Registry Identity

NPI1174246060
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameSTACI LYN JACKSONCredential: LMFT
Location Address1136 MAIN STLeicester, MA 01524-1349
Mailing Address436 Southbridge St., Suite 2, #1006Auburn, MA 01501 · (607) 207-6681
Phone(607) 207-6681
Sole ProprietorYes
Medical School CMSOtherGraduated 2015
Enumeration DateSeptember 26, 2022
Last NPPES UpdateAugust 12, 20252 updates tracked since enumeration
NPPES CertifiedAugust 12, 2025
✔ NPI 1174246060 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in MA · 1836
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
1136 MAIN ST, Leicester, MA 01524
Open in Google Maps ↗

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Harvard Pilgrim Health Care.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Staci Lyn Jackson Lmft is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6305336074
PECOS Enrollment IDI20251114000535
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Staci Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Vine Counseling PLLC
Same address
Marriage & Family Therapist
1136 MAIN ST
Leicester, MA 01524
  • Reassigned Medicare billing, Massachusetts enrollment
NPI 1780560771 (607) 207-6681

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES

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

VINE COUNSELING PLLC
Marriage & Family Therapist
1136 MAIN ST
LEICESTER, MA 01524
Worcester County (607) 207-6681

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 Staci Jackson's NPI number?

The NPI number for Staci Jackson is 1174246060. It was assigned to this individual provider in the NPPES registry on September 26, 2022.

Where is Staci Jackson located?

Staci Jackson practices at 1136 Main St, Leicester, MA 01524. The listed phone number is (607) 207-6681.

What is Staci Jackson's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Staci Jackson enrolled in Medicare?

Yes. Staci Jackson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Staci Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Staci Jackson reassigns Medicare benefits to Vine Counseling PLLC (Leicester, MA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Staci Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Staci Jackson accept?

Health plans from Anthem Blue Cross and Blue Shield and Harvard Pilgrim Health Care list Staci Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Staci Jackson was last updated on August 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.