MEDICARE: MR. JOHN EDWARD JACKSON BS MS,LMHC,CAP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	3282	FL
2	101YM0800X	Mental Health Counselor	MH8379	FL

General Provider Information

NPI Number	:	1285853481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN EDWARD JACKSON BS MS,LMHC,CAP

Provider Business Mailing Address
First Line	:	6022 NW 91ST WAY
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-4100
Country	:	US
Telephone Number	:	954-720-5523
Fax Number	:

Provider Business Practice Location Address
First Line	:	1851 NW 123RD AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-3825
Country	:	US
Telephone Number	:	954-432-2100
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	09/11/2025

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