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SHANE MICHELL JACKSON LPC
NPI 1922173897
Counselor - Addiction (Substance Use Disorder) in Gilmer, TX

Active since November 22, 2006PECOS Enrolled
115 W TYLER ST, GILMER, TX 75644(903) 746-7643(903) 843-4336 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Shane Michell Jackson Lpc NPPES

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

SHANE MICHELL JACKSON LPC (NPI 1922173897) is an individual addiction (substance use disorder) provider in Gilmer, Texas, licensed in Texas (4128) and active in the NPI registry since November 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1922173897
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameSHANE MICHELL JACKSONCredential: LPC
Location Address115 W TYLER STGilmer, TX 75644-2239
Mailing AddressPo Box 1551Gilmer, TX 75644-1551 · (903) 746-7643 · Fax (903) 843-4336
Phone(903) 746-7643
Fax(903) 843-4336
Sole ProprietorYes
Enumeration DateNovember 22, 2006
Last NPPES UpdateSeptember 11, 2025
✔ NPI 1922173897 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in TX · 4128
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 16480 (TX)

Other Identifiers 2

Other16480TX · Lpc
Other4128TX · Lcdc

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, Molina Healthcare, Providence Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shane Michell Jackson Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Shane Jackson's NPI number?

The NPI number for Shane Jackson is 1922173897. It was assigned to this individual provider in the NPPES registry on November 22, 2006.

Where is Shane Jackson located?

Shane Jackson practices at 115 W Tyler St, Gilmer, TX 75644. The listed phone number is (903) 746-7643.

What is Shane Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Shane Jackson enrolled in Medicare?

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

What insurance does Shane Jackson accept?

Health plans from Blue Cross and Blue Shield of Texas, Molina Healthcare, Providence Health Plan and UnitedHealthcare list Shane 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 Shane Jackson was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.