MEDICARE: ADAM J JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497346696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM J JACKSON

Provider Business Mailing Address
First Line	:	608 S FOREST AVE
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-2525
Country	:	US
Telephone Number	:	618-924-5633
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 S FOREST AVE
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-2525
Country	:	US
Telephone Number	:	618-434-1328
Fax Number	:	618-893-5640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2021
Last Update Date	:	04/21/2026

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Directions to “ ADAM J JACKSON ” Practice Location

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