MYLISA JACKSON (NPI# 1205466869) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205466869 |
| Entity Type | Individual |
| Full Name | MYLISA JACKSON |
| Other Name | MYLISA GOODMAN |
| Practice Address |
401 E Cypress Ave Lompoc CA 93436-6806 |
| Practice Telephone | 8058651940 |
| Mailing Telephone | 8058651940 |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2020-01-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | CA | Other Service Providers |
| Street Address |
401 E CYPRESS AVE |
| City | LOMPOC |
| State | CA |
| Zip Code | 93436-6806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760552855 | Richard Sterling Collett | Marriage & Family Therapist | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2006-11-08 |
| 1003417619 | Danny Michael Takaoka | Counselor | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2020-11-02 |
| 1013552173 | Michelle Gabrielle Wiant | Case Manager/Care Coordinator | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2019-11-13 |
| 1669016754 | Sylvia C Hernandez | Case Manager/Care Coordinator | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2019-10-31 |
| 1346703659 | Viviana Tracz | Case Manager/Care Coordinator | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2019-04-12 |
| 1649777889 | Santa Barbara County Department of Behavioral Wellness | Clinic/Center | 401 E Cypress Ave, Suite 211, 214, 217b, Lompoc, CA 93436 | 2018-04-12 |
| 1689185738 | Roberta Mary Strangfeld-russell | Counselor | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2017-10-17 |
| 1285145482 | Evelyn Andrea Valencia | Counselor | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2017-10-16 |
| 1780107185 | Meghan Erin Bradley | Counselor | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2017-07-18 |
| 1073053229 | Shuriee Gioieni | Marriage & Family Therapist | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2017-03-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225671498 | Bonnie O'brien | Technician | 4174 Sirius Avenue, Lompoc, CA 93436 | 2019-10-21 |
| 1043734056 | Stevens Life Chiropractic, PC | Chiropractor | 217-a West Central Ave, Lompoc, CA 93436 | 2017-08-01 |
| 1548621014 | Kimberly Gaynell Wiley | Home Health Aide | 610 East Pine St #34, Lompoc, CA 93436 | 2016-03-11 |
| 1386017960 | Marcos Paul Cline | Counselor | 117 North 'b' Street, Lompoc, CA 93436 | 2015-11-04 |
| 1487045324 | Angela Rose Robinson | Case Manager/Care Coordinator | 113 North H Street, Suite F, Lompoc, CA 93436 | 2015-02-13 |
| 1851795751 | Alina Staniger | Counselor | 604 W Ocean, Lompoc, CA 93436 | 2014-10-21 |
| 1154750560 | Lompoc Valley Medical Center | General Acute Care Hospital | 303 South C Street, Lompoc, CA 93436 | 2013-11-06 |
| 1598191488 | David Lewis Mcaninch Iv | Dentist | 1111 East Ocean Avenue, Suite 9, Lompoc, CA 93436 | 2013-09-24 |
| 1336407048 | Pamela Jordan | Counselor | 110 S. 'c' St. Ste. A, Family Service Agency, Lompoc, CA 93436 | 2012-05-01 |
| 1316220874 | Zillah J. Hodgkins | Counselor | 513 N G St, Lompoc, CA 93436 | 2011-09-21 |
| Find all providers in zip 93436 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134699770 | Buffi Isaac | Case Manager/Care Coordinator | Santa Barbara County - Department of Behavioral Wellnes, 117 North B St, Lompoc, CA 93436-6901 | 2018-11-27 |
| 1487045324 | Angela Rose Robinson | Case Manager/Care Coordinator | 113 North H Street, Suite F, Lompoc, CA 93436 | 2015-02-13 |
| 1730372004 | Sandra Rives | Case Manager/Care Coordinator | 646 N H St, Lompoc, CA 93436-4519 | 2007-08-21 |
| 1770192254 | Letty Annette Mendoza | Case Manager/Care Coordinator | 401 E Ocean Ave, Lompoc, CA 93436-6828 | 2020-07-30 |
| 1053931337 | Ana C Ordonez Aguilar | Case Manager/Care Coordinator | 117 N B St, Lompoc, CA 93436-6901 | 2020-04-16 |
| 1013552173 | Michelle Gabrielle Wiant | Case Manager/Care Coordinator | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2019-11-13 |
| 1669016754 | Sylvia C Hernandez | Case Manager/Care Coordinator | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2019-10-31 |
| 1497314058 | Steve P. Crofut | Case Manager/Care Coordinator | 117 N B St, Lompoc, CA 93436-6901 | 2019-06-07 |
| 1346703659 | Viviana Tracz | Case Manager/Care Coordinator | 401 E Cypress Ave, Lompoc, CA 93436-6806 | 2019-04-12 |
| 1760957815 | Stephanie Flores | Case Manager/Care Coordinator | 401 E Cypress Ave Fl 2, Lompoc, CA 93436-6806 | 2018-10-04 |
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| 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.