DR. CRYSTAL A. JACKSON (NPI# 1255595948) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255595948 |
| Entity Type | Individual |
| Full Name | DR. CRYSTAL A. JACKSON |
| Credential | PH.D., LLP |
| Practice Address |
3011 W Grand Blvd Ste 413 Detroit MI 48202-3011 |
| Mailing Address |
212 Woodview Ct Rochester Hills MI 48307-4112 |
| Practice Telephone | 5862572295 |
| Mailing Telephone | 5869430563 |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2020-10-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
6301013473 | MI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265081384 | Crystal Jackson | Specialist/Technologist | 2426 Cairns Mill Ct, Charlotte, NC 28269-4083 | 2019-09-11 |
| 1487022919 | Crystal Jackson | Behavior Technician | 3205 Shawnee Trl, Alamogordo, NM 88310 | 2015-09-15 |
| 1598140725 | Crystal Jackson | Licensed Practical Nurse | 1585 Holloway Ray Rd, Mc Intyre, GA 31054-2469 | 2015-07-29 |
| 1336560861 | Crystal Jackson | Counselor | 579 Pimlico Cir, Whitsett, NC 27377-8713 | 2013-12-31 |
| 1215288865 | Crystal Jackson | Rehabilitation Practitioner | 1018 Mosskag Ct, North Las Vegas, NV 89032-7696 | 2012-09-23 |
| 1083879837 | Crystal B Jackson | Specialist | 700 Southlake Cir, Youngsville, LA 70592-5671 | 2008-07-22 |
| 1659986586 | Crystal E Jackson | Behavior Technician | 6622 N Maroa Ave, Fresno, CA 93704-1209 | 2020-09-08 |
| 1093349367 | Crystal Jackson | Counselor | 422 E Lamar Blvd Ste 108, Arlington, TX 76011-3604 | 2020-02-26 |
| 1437796919 | Crystal Rena Jackson | Counselor | 8220 Castor Ave, Philadelphia, PA 19152-2729 | 2019-12-04 |
| 1255981130 | Crystal L Jackson | Case Manager/Care Coordinator | 1290 Chambers Rd, Aurora, CO 80011-7117 | 2019-09-12 |
| Street Address |
3011 W GRAND BLVD STE 413 |
| City | DETROIT |
| State | MI |
| Zip Code | 48202-3011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710584602 | Andrea Irene Martin | Audiologist | 2799 E Grand Blvd, Detroit, MI 48202 | 2020-10-05 |
| 1174132583 | Odei Alayyas | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Boulevard Henry Ford Hospital, Medical Ed, Detroit, MI 48202 | 2020-07-31 |
| 1912529801 | Aroob Nabil Nimer Sweidan | Student in an Organized Health Care Education/Training Program | 2799 West Grand Boulvard, Department of Internal Meidicine, Cfp 1, Detroit, MI 48202 | 2020-05-13 |
| 1306485636 | Katie Burlen-davis | Registered Nurse | 9045 Woodward Ave, Detroit, MI 48202 | 2020-01-03 |
| 1407401250 | Santhalakshmi Angappan | Student in an Organized Health Care Education/Training Program | Henry Ford Hospital Medical Education Department, 2799 W. Grand Boulevard, Detroit, MI 48202 | 2019-08-08 |
| 1851945687 | Walter Mitini Etoh | Nurse Practitioner | Henry Ford Hospital I1 Observation, 2799 W. Grand Blvd, Detroit, MI 48202 | 2019-07-30 |
| 1467913756 | Andrew Michael Schock | Emergency Medicine | Ceci Murrell-harvey, Henry Ford Hospital, 2799 W. Grand. Blvd, Cfp 046, Detroit, MI 48202 | 2019-03-28 |
| 1700363892 | Zaid Al-saheli | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvdl, Cfp 046, Hope Peck, Detroit, MI 48202 | 2018-07-23 |
| 1932690096 | Yusuf Naser Alalwan | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvd. Henry Ford Hospital - Gme Office, Detroit, MI 48202 | 2018-05-24 |
| 1568952729 | Kelvin Sellers | Massage Therapist | 832 Seward, Detriot, MI 48202 | 2018-05-14 |
| Find all providers in zip 48202 | ||||
| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386114163 | Katrina Lynn Griffin | Psychologist | 15017 Liberal St, Detroit, MI 48205-1967 | 2018-12-05 |
| 1063865830 | Gloria A. Love | Psychologist | 19677 Revere, Detroit, MI 48234 | 2016-07-18 |
| 1710316534 | How-adolescent Substance Abuse Program, LLC | Psychologist | 8131 E Outer Dr, Detroit, MI 48213-1323 | 2013-11-02 |
| 1609213354 | Patrick Jumbo Eyo | Psychologist | 7810 Southfield Fwy, Detroit, MI 48228-3580 | 2013-06-03 |
| 1235301656 | Regina Brown | Psychologist | 14540 Faust Ave, Detroit, MI 48223-2321 | 2008-03-26 |
| 1679055982 | Erica Jaske | Psychologist | 40 E Ferry St, Detroit, MI 48202-3802 | 2018-09-04 |
| 1376966572 | Elise Ashley Goulbourne | Psychologist | 5555 Conner St, Suite 1038, Detroit, MI 48213-3448 | 2014-01-24 |
| 1710308598 | Alissa Dugan | Psychologist | 1700 Waterman St, Detroit, MI 48209-2022 | 2013-12-23 |
| 1548606320 | Sherry Ellen Mcrill | Psychologist | 2900 Conner St, Bldg A, Detroit, MI 48215-2407 | 2013-05-20 |
| 1609128503 | Joann Thompson | Psychologist | 2925 Russell St, Detroit, MI 48207-4825 | 2012-10-03 |
| Find all providers in DETROIT | ||||
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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.