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NPI Code Detail

MEDICARE: ERIN ELIZABETH JACKSON

MEDICARE: ERIN ELIZABETH 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
1101YM0800XMental Health Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor195075OH

General Provider Information

NPI Number : 1699584961
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN ELIZABETH JACKSON
Provider Business Mailing Address
First Line : 9083 MENTOR AVE
Second Line :
City : MENTOR
State : OH
Zip : 44060-6462
Country : US
Telephone Number : 440-255-0678
Fax Number :
Provider Business Practice Location Address
First Line : 9083 MENTOR AVE
Second Line :
City : MENTOR
State : OH
Zip : 44060-6462
Country : US
Telephone Number : 440-255-0678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2025
Last Update Date : 02/02/2026

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