Provider Demographics
NPI:1043270093
Name:JACKSON, JILL ALANA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ALANA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1911
Mailing Address - Country:US
Mailing Address - Phone:641-278-1095
Mailing Address - Fax:641-278-1095
Practice Address - Street 1:709 COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1911
Practice Address - Country:US
Practice Address - Phone:641-278-1095
Practice Address - Fax:641-278-1095
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00738101YA0400X, 261QM0801X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14941Medicare ID - Type Unspecified