MEDICARE: JACKSON THERAPY COLLECTIVE (FORMERLY TALIA JACKSON PSYCHOTHERAPY SERVICES)

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1780536318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON THERAPY COLLECTIVE (FORMERLY TALIA JACKSON PSYCHOTHERAPY SERVICES)

Provider Business Mailing Address
First Line	:	2600 WAYZATA BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2123
Country	:	US
Telephone Number	:	612-444-1745
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 WAYZATA BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2123
Country	:	US
Telephone Number	:	612-444-1745
Fax Number	:	612-484-4557

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST, OWNER
Name	:	DR. TALIA AMO JACKSON
Credential	:	PSY.D., LP
Telephone Number	:	612-444-1745

Provider Enumeration Date	:	02/14/2026
Last Update Date	:	02/14/2026

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