JACKSON LAKE LAC
NPI 1720763717
Counselor - Mental Health in Little Rock, AR

Q: What is Jackson Lake's NPI number?

The NPI number for Jackson Lake is 1720763717. It was assigned to this individual provider in the NPPES registry on June 19, 2023.

Q: What is Jackson Lake's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jackson Lake was last updated on June 19, 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 June 19, 2023

10020 N RODNEY PARHAM RD STE G, LITTLE ROCK, AR 72227(501) 831-4314 Get Directions Write a Review

NPPES record last updated: June 19, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Jackson Lake Lac NPPES

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

JACKSON LAKE LAC (NPI 1720763717) is an individual mental health provider in Little Rock, Arkansas, licensed in Arkansas (A2305013) and active in the NPI registry since June 2023.

NPPES Registry Identity

NPI1720763717

Entity TypeIndividualMale

Primary Taxonomy101YM0800X

Provider Legal NameJACKSON LAKECredential: LAC

Location Address10020 N RODNEY PARHAM RD STE GLittle Rock, AR 72227-5588

Mailing Address10020 N Rodney Parham Rd Ste GLittle Rock, AR 72227-5588

Phone(501) 831-4314

Sole ProprietorYes

Enumeration DateJune 19, 2023

NPPES CertifiedJune 19, 2023

✔ NPI 1720763717 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 AR · A2305013

10020 N RODNEY PARHAM RD STE G, Little Rock, AR 72227

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Other Providers at the Same Location NPPES

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

MS. ALYSON RACHELLE PITTMAN LPC

Counselor

10020 N RODNEY PARHAM RD STE G
LITTLE ROCK, AR 72227

Pulaski County (501) 680-2602

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 Jackson Lake's NPI number?

The NPI number for Jackson Lake is 1720763717. It was assigned to this individual provider in the NPPES registry on June 19, 2023.

Where is Jackson Lake located?

Jackson Lake practices at 10020 N Rodney Parham Rd Ste G, Little Rock, AR 72227. The listed phone number is (501) 831-4314.

What is Jackson Lake's specialty?

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

When was this NPI record last updated?

The NPPES record for Jackson Lake was last updated on June 19, 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.