Miranda Jean Jackson, | |
55981 E Colfax Ave, Strasburg, CO 80136-8014 | |
(719) 632-5700 | |
(719) 344-7817 |
Full Name | Miranda Jean Jackson |
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Gender | Female |
Speciality | Counselor - Professional |
Location | 55981 E Colfax Ave, Strasburg, Colorado |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1750683447 | NPI | - | NPPES |
28034546 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | LPC.0011343 (Colorado) | Primary |
Entity Name | Peak Vista Community Health Centers |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1730166034 PECOS PAC ID: 4688583974 Enrollment ID: O20031110000337 |
Mailing Address | Practice Location Address |
---|---|
Miranda Jean Jackson, 3205 N Academy Blvd, Suite 130, Colorado Springs, CO 80917-5147 Ph: (719) 632-5700 | Miranda Jean Jackson, 55981 E Colfax Ave, Strasburg, CO 80136-8014 Ph: (719) 632-5700 |
Veronica Cobian, Counselor Medicare: Not Enrolled in Medicare Practice Location: 59900 E 64th Ave, Strasburg, CO 80136 Phone: 720-626-6722 | |
Vennessia Marie Jimenez, LPC, NCC Counselor Medicare: Medicare Enrolled Practice Location: 1517 Main St, Strasburg, CO 80136 Phone: 720-655-0093 | |
Tanya Marie Goble, CAS Counselor Medicare: Not Enrolled in Medicare Practice Location: 56770 E Colfax, Strasburg, CO 80136 Phone: 303-359-3958 |