LARISSA M. JACKSON (NPI# 1700490059) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700490059 |
| Entity Type | Individual |
| Full Name | LARISSA M. JACKSON |
| Credential | PLADC |
| Practice Address |
8502 Mormon Bridge Rd Omaha NE 68152-1929 |
| Mailing Address |
3327 N 163rd Plz Apt 304 Omaha NE 68116-2149 |
| Practice Telephone | 4024558303 |
| Mailing Telephone | 4025100668 |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2020-09-03 |
| 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) |
P-1781 | NE | Behavioral Health & Social Service Providers |
| Street Address |
8502 MORMON BRIDGE RD |
| City | OMAHA |
| State | NE |
| Zip Code | 68152-1929 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326124397 | Cooper Village | Psychiatric Residential Treatment Facility | 8502 Mormon Bridge Rd, Omaha, NE 68152-2150 | 2006-10-31 |
| 1649887829 | Taylor Sue Williams | Counselor | 8502 Mormon Bridge Rd, Omaha, NE 68152-1929 | 2020-09-30 |
| 1144834144 | Corinne Jae Miller | Registered Nurse | 8502 Mormon Bridge Rd, Omaha, NE 68152-1929 | 2020-09-07 |
| 1619581790 | Crystal Sanchez | Registered Nurse | 8502 Mormon Bridge Rd, Omaha, NE 68152-1929 | 2020-09-04 |
| 1801414768 | Amanda Fouts | Counselor | 8502 Mormon Bridge Rd, Omaha, NE 68152-1929 | 2020-07-08 |
| 1245854710 | Jessica Bruce | Counselor | 8502 Mormon Bridge Rd, Omaha, NE 68152-1929 | 2020-06-01 |
| 1811461254 | Taylar E Mason | Counselor | 8502 Mormon Bridge Rd, Omaha, NE 68152-1929 | 2019-01-18 |
| 1992276752 | Melina Amanda Hickey | Counselor | 8502 Mormon Bridge Rd, Omaha, NE 68152-1929 | 2018-12-05 |
| 1891272514 | Chantel Bruha | Counselor | 8502 Mormon Bridge Rd, Omaha, NE 68152-1929 | 2018-07-25 |
| 1164926101 | Sarah Preston | Counselor | 8502 Mormon Bridge Rd, Omaha, NE 68152-1929 | 2018-03-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811392889 | Molly Motsinger | Physical Therapy Assistant | 6020 Country Club Oaks Place, Omaha, NE 68152 | 2014-11-03 |
| 1043625023 | Joseph Kent | Psychiatry & Neurology | 7101 Newport Ave Dept Of, Omaha, NE 68152 | 2014-06-27 |
| 1043588924 | Generation Hope Family Counseling & Consulting | Counselor | 6677 Sorensen Parkway, Omaha, NE 68152 | 2011-12-07 |
| 1144534736 | Stefany Bowden | Speech-Language Pathologist | 12849 Calhoun Rd, Omaha, NE 68152-1117 | 2010-08-05 |
| 1255783742 | Horseplay Acres Therapy Services | Speech-Language Pathologist | 12849 Calhoun Rd, Omaha, NE 68152-1117 | 2016-07-07 |
| 1588006993 | Jessica M Vandercoy | Counselor | 5605 Northern Hills Dr, Omaha, NE 68152-1192 | 2013-07-26 |
| 1699947853 | Erika Lee | Physical Therapist | 6533 Country Squire Ln, Omaha, NE 68152-1411 | 2008-03-27 |
| 1336365311 | Kelly S. Schroeder | Emergency Medicine | 10985 N 60th St, Omaha, NE 68152-1459 | 2007-04-18 |
| 1477875649 | James Bane | General Practice | 11106 N 61st St, Omaha, NE 68152-1470 | 2010-02-15 |
| 1437640760 | Tonya M Goodwin-daly | Counselor | 9910 N 48th St Ste 111, Omaha, NE 68152-1548 | 2018-05-22 |
| Find all providers in zip 68152 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154930386 | Harry D Washington IIi | Counselor | 1299 Farnam, Omaha, NE 68105-6811 | 2020-07-23 |
| 1003432386 | Judi Scott | Counselor | 9733 Grant St, Omaha, NE 68134-5619 | 2020-06-22 |
| 1508481086 | William Sean Mcneil | Counselor | 3128 N 168th Ave, Omaha, NE 68116-2614 | 2020-06-10 |
| 1063048114 | Tiffany Gormley | Counselor | 18047 Oak St, Omaha, NE 68130-6093 | 2020-03-20 |
| 1851939565 | Mat Lavern Zollicoffer | Counselor | 1502 N 58th St, Omaha, NE 68104-4820 | 2019-12-12 |
| 1184269235 | Gary Darryl Mosley Sr. | Counselor | Tamarak Building Suite 101 G, 3035 Harney Street, Omaha, NE 68131-3500 | 2019-11-13 |
| 1437792439 | Lisa Ann Osler | Counselor | 1301 S 31st St Apt 15, Omaha, NE 68105-2048 | 2019-10-22 |
| 1154970176 | Loren Dexter | Counselor | 13808 U St, Omaha, NE 68137-2904 | 2019-09-11 |
| 1912550823 | Kelley A Lutjen | Counselor | 401 S 39th St, Omaha, NE 68131-3710 | 2019-07-19 |
| 1356908735 | David Brinkerhoff Ballard IIi | Counselor | 902 N 95th Plz Apt 5, Omaha, NE 68114-2561 | 2019-05-21 |
| Find all providers in OMAHA | ||||
Please comment or provide details below to improve the information on LARISSA M. 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.