SHANE MICHELL JACKSON LPC
NPI 1922173897
Counselor - Addiction (Substance Use Disorder) in Gilmer, TX
NPI Status: Active since November 22, 2006
Contact Information
115 W TYLER ST
GILMER, TX
ZIP 75644
Phone: (903) 746-7643
Fax: (903) 843-4336
- Individual
- Female
- Counselor
- Addiction (Substance Use Disorder)
- Accepts Insurance
- PECOS Enrolled
About SHANE JACKSON
This page provides the complete NPI Profile along with additional information for Shane Jackson, a provider established in Gilmer, Texas with a medical specialization in Counselor, focusing in addiction (substance use disorder) . The healthcare provider is registered in the NPI registry with number 1922173897 assigned on November 2006. The practitioner's primary taxonomy code is 101YA0400X with license number 4128 (TX). The provider is registered as an individual and her NPI record was last updated one year ago.
- NPI
- 1922173897
- Provider Name
- SHANE MICHELL JACKSON LPC
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 115 W TYLER ST GILMER, TX 75644
- Location Phone
- (903) 746-7643
- Location Fax
- (903) 843-4336
- Mailing Address
- PO BOX 1551 GILMER, TX 75644
- Mailing Phone
- (903) 746-7643
- Mailing Fax
- (903) 843-4336
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 11-22-2006
- Last Update Date
- 09-11-2025
- Code Navigator
A Substance Abuse or Addiction Counselor like Shane Jackson advices patients who experience alcoholism, drug addiction, eating disorders, mental health issues, or other mental or behavioral problems. Substance Abuse counselors provide treatment and support to help clients recover from addiction or modify problem behaviors. Many counselors incorporate the principles of 12-step programs, such as Alcoholics Anonymous (AA). They educate clients how to cope with stress and life’s issues in ways that help them recover. Counselors also help patients improve their personal relationships and find ways to discuss their addiction or other problems with family and friends.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Counselor Addiction (Substance Use Disorder)
- Taxonomy Code
- 101YA0400X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 4128
- License State
- TX
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | 16480 (TX) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Advantage Bronze HMO? 204 - HMO
- Blue Advantage Bronze HMO? 301 - HMO
- Blue Advantage Bronze HMO? Standard - HMO
- Blue Advantage Gold HMO? 206 - HMO
- Blue Advantage Gold HMO? 603 - HMO
- Blue Advantage Gold HMO? Standard - HMO
- Blue Advantage Plus Bronze? 303 - POS
- Blue Advantage Plus Bronze? 305 - POS
- Blue Advantage Plus Bronze? Standard - POS
- Blue Advantage Plus Gold? 203 - POS
- Molina Gold Core 1640 - HMO
- Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
- Molina Gold Core 1640 Plus with Adult Vision - HMO
- Molina Gold Saver 750 - HMO
- Molina Gold Saver 750 Plus with Adult Dental and Vision - HMO
- Molina Gold Saver 750 Plus with Adult Vision - HMO
- Molina Gold Standard - HMO
- Molina Silver Core - HMO
- Molina Silver Core Plus with Adult Dental and Vision - HMO
- Molina Silver Core Plus with Adult Vision - HMO
- Connect 1500 Gold - EPO
- Connect 6000 Silver - EPO
- Connect 9800 Bronze - EPO
- HSA Qualified 7500 Bronze - Choice Network - EPO
- HSA-E Qualified 7500 Bronze - Signature Network - EPO
- Providence Oregon Standard Bronze Plan - Choice Network - EPO
- Providence Oregon Standard Bronze Plan - Signature Network - EPO
- Providence Oregon Standard Gold Plan - Choice Network - EPO
- Providence Oregon Standard Gold Plan - Signature Network - EPO
- Providence Oregon Standard Silver Plan - Choice Network - EPO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) - HMO
- UHC Bronze Essential ($0 Virtual Urgent Care) - HMO
- UHC Bronze Standard - HMO
- UHC Bronze Standard+ (Dental + Vision) - HMO
- UHC Gold Advantage ($0 Virtual Urgent Care, $8 Tier 2 Rx) - HMO
- UHC Gold Advantage+ ($0 Virtual Urgent Care, $8 Tier 2 Rx, Dental + Vision) - HMO
- UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $8 Tier 2 Rx) - HMO
- UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $8 Tier 2 Rx, Dental + Vision) - HMO
- UHC Gold Standard - HMO
- UHC Kelsey-Seybold Bronze Copay Focus $0 Indiv Med Ded - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 16480 | OTHER (01) | TX | LPC |
| 4128 | OTHER (01) | TX | LCDC |
Medicare Participation & PECOS Enrollment Status
Shane Jackson is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): No
Eligible to Order or Refer Power Mobility Devices: No
Reviews for SHANE MICHELL JACKSON LPC
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1922173897, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 73. The final step is to find the difference between that total and the next multiple of ten (80 - 73 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 73 is 80. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1922173897, enumerated as an "individual" on November 22, 2006.
The provider is located at 115 W TYLER ST GILMER, TX 75644 and the phone number is (903) 746-7643.
Counselor with taxonomy code 101YA0400X and a focus in Addiction (Substance Use Disorder).
The provider might be accepting Accepts: Blue Cross and Blue Shield of Texas, Molina. Please consult your insurance carrier or call the provider to verify.
