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MS. MARY THERESA JACKSON LPC
NPI 1699121129
Counselor - Professional in Ellabell, GA

Active since May 13, 2016PECOS Enrolled
345 OLD CUYLER RD, ELLABELL, GA 31308(912) 320-3205 Get Directions Write a Review

NPPES record last updated: November 27, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 11, 2020, May 13, 2016 (2 updates tracked since 2016).

About Ms. Mary Theresa Jackson Lpc NPPES

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

MS. MARY THERESA JACKSON LPC (NPI 1699121129) is an individual professional provider in Ellabell, Georgia, licensed in Georgia (LPC011711) and active in the NPI registry since May 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2016).

NPPES Registry Identity

NPI1699121129
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameMS. MARY THERESA JACKSONCredential: LPC
Location Address345 OLD CUYLER RDEllabell, GA 31308-5858
Mailing Address345 Old Cuyler RdEllabell, GA 31308-5858 · (912) 320-3205
Phone(912) 320-3205
Sole ProprietorYes
Medical School CMSOtherGraduated 2016
Enumeration DateMay 13, 2016
Last NPPES UpdateNovember 27, 20232 updates tracked since enumeration
NPPES CertifiedSeptember 11, 2020
✔ NPI 1699121129 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in GA · LPC011711
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
345 OLD CUYLER RD, Ellabell, GA 31308
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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 (PECOS)

Ms. Mary Theresa Jackson Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1759876022
PECOS Enrollment IDI20251223004388
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 Mary Jackson's NPI number?

The NPI number for Mary Jackson is 1699121129. It was assigned to this individual provider in the NPPES registry on May 13, 2016.

Where is Mary Jackson located?

Mary Jackson practices at 345 Old Cuyler Rd, Ellabell, GA 31308. The listed phone number is (912) 320-3205.

What is Mary Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Mary Jackson enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Mary Jackson was last updated on November 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.