| Miranda Jean Jackson, | |
|
55981 E Colfax Ave, Strasburg, CO 80136-8014 | |
| (719) 632-5700 | |
| (719) 344-7817 |
| Full Name | Miranda Jean Jackson |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 55981 E Colfax Ave, Strasburg, Colorado |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750683447 | NPI | - | NPPES |
| 28034546 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC.0011343 (Colorado) | Primary |
| Entity Name | Peak Vista Community Health Centers |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1730166034 PECOS PAC ID: 4688583974 Enrollment ID: O20031110000337 |
| Mailing Address | Practice Location Address |
|---|---|
| Miranda Jean Jackson, 3205 N Academy Blvd, Suite 130, Colorado Springs, CO 80917-5147 Ph: (719) 632-5700 | Miranda Jean Jackson, 55981 E Colfax Ave, Strasburg, CO 80136-8014 Ph: (719) 632-5700 |
Veronica Cobian, Counselor Medicare: Not Enrolled in Medicare Practice Location: 59900 E 64th Ave, Strasburg, CO 80136 Phone: 720-626-6722 | |
Vennessia Marie Jimenez, LPC, NCC Counselor Medicare: Medicare Enrolled Practice Location: 1517 Main St, Strasburg, CO 80136 Phone: 720-655-0093 | |
Tanya Marie Goble, CAS Counselor Medicare: Not Enrolled in Medicare Practice Location: 56770 E Colfax, Strasburg, CO 80136 Phone: 303-359-3958 |