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MR. JAISSEN M JACKSON LMHC
NPI 1275074171
Counselor - Mental Health in Providence, RI

Active since March 13, 2017PECOS EnrolledAccepts Medicare Assignment
194 WEBSTER AVE, PROVIDENCE, RI 02909(401) 261-0321 Get Directions Write a Review

NPPES record last updated: October 10, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 10, 2025, Oct 23, 2019, Mar 13, 2017 (3 updates tracked since 2017).

About Mr. Jaissen M Jackson Lmhc NPPES

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

MR. JAISSEN M JACKSON LMHC (NPI 1275074171) is an individual mental health provider in Providence, Rhode Island, licensed in Rhode Island (MHC01094) and active in the NPI registry since March 2017. He is enrolled in Medicare PECOS and is a graduate of Other (2016).

NPPES Registry Identity

NPI1275074171
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameMR. JAISSEN M JACKSONCredential: LMHC
Location Address194 WEBSTER AVEProvidence, RI 02909-3818
Mailing Address530 N Main StProvidence, RI 02904-5762 · (401) 276-4100 · Fax (401) 276-4124
Phone(401) 261-0321
Sole ProprietorNo
Medical School CMSOtherGraduated 2016
Enumeration DateMarch 13, 2017
Last NPPES UpdateOctober 10, 20253 updates tracked since enumeration
NPPES CertifiedOctober 10, 2025
✔ NPI 1275074171 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in RI · MHC01094
194 WEBSTER AVE, Providence, RI 02909
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Jaissen M Jackson Lmhc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8022536739
PECOS Enrollment IDI20250516001269
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.

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 Jaissen Jackson's NPI number?

The NPI number for Jaissen Jackson is 1275074171. It was assigned to this individual provider in the NPPES registry on March 13, 2017.

Where is Jaissen Jackson located?

Jaissen Jackson practices at 194 Webster Ave, Providence, RI 02909. The listed phone number is (401) 261-0321.

What is Jaissen Jackson's specialty?

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

Is Jaissen Jackson enrolled in Medicare?

Yes. Jaissen Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Jaissen Jackson was last updated on October 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.