Ms Mary Theresa Jackson, LPC is a medicare enrolled "Counselor - Professional" provider in Ellabell, Georgia. She graduated from healthcare school in 2016 and has 10 years of diverse experience with area of expertise as Mental Health Counselor. Her current practice location is
345 Old Cuyler Rd, Ellabell, Georgia. You can reach out to her office (for appointments etc.) via phone at
(912) 320-3205.
Ms Mary Theresa Jackson is licensed to practice in Georgia (license number LPC011711) and she also participates in the medicare program. She
may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1699121129.
Healthcare Provider's Profile
| Full Name | Ms Mary Theresa Jackson |
|---|
| Gender | Female |
|---|
| Speciality | Mental Health Counselor |
|---|
| Experience | 10 Years |
|---|
| Location | 345 Old Cuyler Rd, Ellabell, Georgia |
|---|
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
|---|
Medical Education and Training:
- Ms Mary Theresa Jackson graduated from medical school in 2016
NPI Data:
- NPI Number: 1699121129
- Provider Enumeration Date: 05/13/2016
- Last Update Date: 11/27/2023
Medicare PECOS Information:
- PECOS PAC ID: 1759876022
- Enrollment ID: I20251223004388
Medical Identifiers
Medical identifiers for Ms Mary Theresa Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1699121129 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | LPC011711 (Georgia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Mary Theresa Jackson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ms Mary Theresa Jackson, LPC
345 Old Cuyler Rd,
Ellabell, GA 31308-5858
Ph: (912) 320-3205 | Ms Mary Theresa Jackson, LPC
345 Old Cuyler Rd,
Ellabell, GA 31308-5858
Ph: (912) 320-3205 |
Reviews and Comments