SHYRA D'ANN JACKSON (NPI# 1134635824) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134635824 |
| Entity Type | Individual |
| Full Name | SHYRA D'ANN JACKSON |
| Practice Address |
12960 San Pablo Ave Richmond CA 94805-1307 |
| Mailing Address |
1901 Church Ln San Pablo CA 94806-3707 |
| Practice Telephone | 5102152280 |
| Practice Fax Number | 5102152283 |
| Mailing Telephone | 5102152280 |
| Mailing Fax Number | 5102152283 |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2017-12-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
12554-R | CA | Behavioral Health & Social Service Providers |
| Street Address |
12960 SAN PABLO AVE |
| City | RICHMOND |
| State | CA |
| Zip Code | 94805-1307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134240781 | Ujma Family Recovery Services | Community/Behavioral Health | 12960 San Pablo Ave, Richmond, CA 94805-1307 | 2007-04-02 |
| 1639780620 | Jaynelle Kopp | Counselor | 12960 San Pablo Ave, Richmond, CA 94805-1307 | 2020-08-12 |
| 1114489135 | Donna Marie Youry | Counselor | 12960 San Pablo Ave, Richmond, CA 94805-1307 | 2019-04-01 |
| 1932669561 | Michelle Patricia Lineaweaver | Counselor | 12960 San Pablo Ave, Richmond, CA 94805-1307 | 2019-03-20 |
| 1700273950 | Goretha Johnson | Counselor | 12960 San Pablo Ave, Richmond, CA 94805-1307 | 2015-04-24 |
| 1881002541 | Ujima Family Recovery Services | Substance Abuse Rehabilitation Facility | 12960 San Pablo Ave, Richmond, CA 94805-1307 | 2014-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134622038 | Edward Trujano | Behavioral Analyst | 616 40th St, Richmond, CA 94805 | 2018-03-16 |
| 1568900439 | John Edward Tysell Jr. | Internal Medicine | 437 Carlston Street, Richmond, CA 94805 | 2017-02-10 |
| 1043661952 | Alejandra Cardenas | Counselor | 4101 Macdonald Avenue, Richmond, CA 94805 | 2016-06-22 |
| 1568582229 | Susan Denny | Marriage & Family Therapist | 207 37th Street, Richmond, CA 94805 | 2007-03-29 |
| 1548312689 | Wendy E Maron | Marriage & Family Therapist | 630 Humboldt St, Richmond, CA 94805 | 2007-01-17 |
| 1518015866 | Community Health for Asian Americans | Community/Behavioral Health | 207 37th St, Richmond, CA 94805 | 2007-01-05 |
| 1215496799 | Makenna Newton | Counselor | 303 41st St, Richmond, CA 94805 | 2019-03-14 |
| 1508399189 | Alejandra Olguin | Social Worker | 205 39th St, Richmond, CA 94805 | 2017-04-10 |
| 1760872451 | Deyda Mendoza | Counselor | 205 39th St, Richmond, CA 94805 | 2015-02-02 |
| 1245664036 | Leonard Deguzman | Counselor | 207 37th St, Richmond, CA 94805 | 2013-08-28 |
| Find all providers in zip 94805 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225640790 | Cindy Beardsley | Counselor | 3414 Solano Ave, Richmond, CA 94805-1745 | 2020-08-17 |
| 1972114585 | Lynn Nicole Thompson | Counselor | 1621 Foxhaven Dr, Richmond, KY 40475-1056 | 2020-08-17 |
| 1346867058 | Kristin Fitzgerald | Counselor | 2320 Broad Rock Blvd, Richmond, VA 23224-4812 | 2020-06-29 |
| 1891317269 | Padme Wellness, LLC | Counselor | 704 N 1st St, Richmond, VA 23219-1310 | 2020-05-08 |
| 1548891740 | Jeanne Evelyn Pizzagrani I | Counselor | 2355 Lancaster Dr Apt 7, Richmond, CA 94806-3046 | 2020-01-28 |
| 1518445204 | Crystal Lester-lewis | Counselor | 4325 Mylan Rd, Richmond, VA 23223-2273 | 2018-08-03 |
| 1972098416 | Rachelle Raquel Valenzuela | Counselor | 666 38th St, Richmond, CA 94805-1702 | 2018-06-27 |
| 1144724964 | Natalie Orme Waters | Counselor | 681 Hioaks Rd Ste C&j, Richmond, VA 23225-4043 | 2018-03-19 |
| 1669974358 | Kisha Monique Jones | Counselor | 208 23rd St, Richmond, CA 94804-1830 | 2018-03-08 |
| 1659889723 | Karon Harris | Counselor | 9609 Jefferson Davis Highway, Richmond, VA 23237 | 2018-01-11 |
| Find all providers in RICHMOND | ||||
Please comment or provide details below to improve the information on SHYRA D'ANN JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.