DERISHA JACKSON (NPI# 1780968628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780968628 |
| Entity Type | Individual |
| Full Name | DERISHA JACKSON |
| Practice Address |
351 N Air Depot Blvd Suite S Midwest City OK 73110-1700 |
| Mailing Address |
13525 N Hollow Rock Rd. Apt D Oklahoma City OK 73120 |
| Practice Telephone | 4056106540 |
| Mailing Telephone | 2092424270 |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2011-10-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| Street Address |
351 N AIR DEPOT BLVD SUITE S |
| City | MIDWEST CITY |
| State | OK |
| Zip Code | 73110-1700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215047923 | Jason Sewell | Physical Therapy Assistant | 351 N Air Depot Blvd, Midwest City, OK 73110-1700 | 2006-08-30 |
| 1437522273 | Julia Massie | Speech-Language Pathologist | 351 N Air Depot Blvd, Midwest City, OK 73110-1700 | 2015-11-02 |
| 1922479609 | Tina Marie Johnson | Counselor | 351 N Air Depot Blvd, Suite M, Midwest City, OK 73110-1700 | 2015-10-07 |
| 1710373063 | Gretchen Schell | Behavioral Analyst | 351 N Air Depot Blvd, Midwest City, OK 73110-1700 | 2015-04-14 |
| 1144623414 | Jessie Benfield-boik | Social Worker | 351 N Air Depot Blvd, Suite M, Midwest City, OK 73110-1700 | 2014-10-01 |
| 1396156493 | Stephanie M Bond | Counselor | 351 N Air Depot Blvd, Suite M, Midwest City, OK 73110-1700 | 2014-05-13 |
| 1205256112 | Therapy Link Solutions LLC | Counselor | 351 N Air Depot Blvd, Suite Q, Midwest City, OK 73110-1700 | 2014-04-17 |
| 1114340940 | Michael Annancy | Counselor | 351 N Air Depot Blvd, Suite M, Midwest City, OK 73110-1700 | 2014-01-30 |
| 1265855498 | Anna Gronneberg | Case Management | 351 N Air Depot Blvd, Suite M, Midwest City, OK 73110-1700 | 2014-01-23 |
| 1831438290 | Michelle Mckelly | Counselor | 351 N Air Depot Blvd, Suite M, Midwest City, OK 73110-1700 | 2013-02-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255939377 | Torry E Elston | Technician/Technologist | 5908 Se 15th St, Midwest City, OK 73110 | 2020-10-12 |
| 1083225783 | Daniel B Nguyen | Pharmacist | 1601 S Air Depot, Midwest City, OK 73110 | 2020-08-14 |
| 1114494903 | Tiandrea Jeanae Neal | Behavioral Analyst | 1212 S. Air Depot, Ste 17, Midwest City, OK 73110 | 2018-10-30 |
| 1467902593 | Brian Christopher Lewis | Case Manager/Care Coordinator | 8616 Cedar Ridge Drive, Midwest City, OK 73110 | 2016-10-13 |
| 1669839312 | National Iom, Pllc | Electrodiagnostic Medicine | 1205 S. Air Depot # 102, Midwest City, OK 73110 | 2016-01-26 |
| 1003292210 | Alexandrea Funston | Speech-Language Pathologist | 224 E Blossom Drive, Midwest City, OK 73110 | 2015-08-11 |
| 1184053399 | Ronya Caraway | Community/Behavioral Health | 7901 Ne 10th, B106, Midwest City, OK 73110 | 2013-11-07 |
| 1245678374 | Layfette Lamar Fletcher | Counselor | 405 Delia Street, Midwest City, OK 73110 | 2013-06-11 |
| 1114364163 | Kathryn Ann Gray | Social Worker | 1391 North Midwest Blvd., Midwest City, OK 73110 | 2013-05-31 |
| 1841542545 | Steven Atkins Akinnfest | Counselor | 417 Reed Place, Midwest City, OK 73110 | 2012-10-05 |
| Find all providers in zip 73110 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467068098 | Mckenzie Mcguffee | Counselor | 717 Briarcrest Dr, Midwest City, OK 73110-1619 | 2020-09-18 |
| 1457883662 | Melissa Lynn Russell | Counselor | 808 Hunters Run, Midwest City, OK 73130-4528 | 2017-03-28 |
| 1629427612 | Tiffney Simmons | Counselor | 8818 Ne 13th St, Midwest City, OK 73110-7120 | 2016-06-09 |
| 1639536212 | Jenell Mapp | Counselor | 1716 S Willow Wind Dr, Midwest City, OK 73130-6511 | 2016-01-27 |
| 1831564251 | Traci Johnson | Counselor | 8811 Fairfield Greens Dr, Midwest City, OK 73110-8015 | 2015-12-10 |
| 1396115788 | Ramona Nicholson | Counselor | 10525 Quail Run Rd, Midwest City, OK 73130-7039 | 2015-09-29 |
| 1619346103 | Heather Kelpine | Counselor | 9677 Oak Tree Ter, Midwest City, OK 73130-3537 | 2015-09-15 |
| 1164842084 | Willard Frazier Jr. | Counselor | 4406 N Shadybrook Dr, Midwest City, OK 73110-3437 | 2014-04-17 |
| 1467877019 | Megan Leigh Kilmer | Counselor | 1800 Rulane Dr, Midwest City, OK 73110-2561 | 2014-02-19 |
| 1437573672 | Anthony Jerome Gilliam | Counselor | 2424 N Key Blvd, Midwest City, OK 73110-4662 | 2014-02-07 |
| Find all providers in MIDWEST CITY | ||||
| City | MIDWEST CITY |
| Zip Code | 73110 |
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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.