RUSSELL NEILEND JACKSON PHD
NPI 1598426884
Psychologist - Group Psychotherapy in Columbia, MO

Q: What is Russell Jackson's NPI number?

The NPI number for Russell Jackson is 1598426884. It was assigned to this individual provider in the NPPES registry on January 7, 2022.

Q: What is Russell Jackson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Group Psychotherapy, with taxonomy code 103TP2701X.

Q: When was this NPI record last updated?

The NPPES record for Russell Jackson was last updated on September 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.

Active since January 07, 2022PECOS Enrolled

414 E BROADWAY STE 201A, COLUMBIA, MO 65201(515) 460-0047 Get Directions Write a Review

NPPES record last updated: September 29, 2025. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About Russell Neilend Jackson Phd NPPES

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

RUSSELL NEILEND JACKSON PHD (NPI 1598426884) is an individual group psychotherapy provider in Columbia, Missouri, licensed in Missouri (2021011992) and active in the NPI registry since January 2022. He is enrolled in Medicare PECOS, maintains a secondary practice location in Columbia, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1598426884

Entity TypeIndividualMale

Primary Taxonomy103TP2701X

Provider Legal NameRUSSELL NEILEND JACKSONCredential: PHD

Location Address414 E BROADWAY STE 201AColumbia, MO 65201-4489

Mailing AddressPo Box 843966Kansas City, MO 64184-3966 · (573) 884-3300 · Fax (573) 884-0943

Phone(515) 460-0047

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateJanuary 7, 2022

Last NPPES UpdateSeptember 29, 2025

NPPES CertifiedSeptember 29, 2025

✔ NPI 1598426884 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPsychologist · Group PsychotherapyBehavioral Health & Social Service Providers

Taxonomy Code103TP2701X

License✔ Licensed in MO · 2021011992

Definition

A psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identify and capitalize on developmental and healing possibilities embedded in the interpersonal/intrapersonal functioning of individual group members as well as collectively for the group. Emphasis is placed on the use of group dynamics to assist and treat individual group members. The specialty is applicable to all age groups, children, adolescents, adults and older adults, for a wide variety of conditions and concerns, and in numerous and diverse settings.

Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 2021011992 (MO)

Also ListedPsychologist · CounselingTaxonomy 103TC1900X · License 2021011992 (MO)

414 E BROADWAY STE 201A, Columbia, MO 65201

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Secondary Practice Location 1

Location 1211 S 8th StColumbia, MO 65201-4868 · Phone (573) 882-4677 · Fax (573) 882-4583

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Russell Neilend Jackson Phd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7416446927

PECOS Enrollment IDI20251027000164

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 Russell Jackson's NPI number?

The NPI number for Russell Jackson is 1598426884. It was assigned to this individual provider in the NPPES registry on January 7, 2022.

Where is Russell Jackson located?

Russell Jackson practices at 414 E Broadway Ste 201A, Columbia, MO 65201. The listed phone number is (515) 460-0047.

What is Russell Jackson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Group Psychotherapy, with taxonomy code 103TP2701X.

Is Russell Jackson enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Russell Jackson was last updated on September 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.