MS. CANDIS L JACKSON (LMHC) – Mental Health Counselor, NPI 1104004746
Mental Health Counselor
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,018 MENTAL HEALTH COUNSELOR in FL
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Provider Addresses for MS. CANDIS L JACKSON (LMHC)
3460, Depew Avenue, Port Charlotte, Charlotte County, Florida, 33952, United States
PORT CHARLOTTE, FL 339527015
Phone: (941) 764-6300
Fax: (941) 764-7297
Type: Location
PO BOX 512139
PUNTA GORDA, FL 339512139
Phone: (941) 625-5895
Fax: (941) 625-1047
Type: Mailing
4161 TAMIAMI TRL STE 304D
PORT CHARLOTTE, FL 339529254
Phone: (941) 625-5895
Fax: (941) 625-1047
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-05-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240522004291 | I | Mental Health Counselor | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33952)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | FL | |
| P S Y C H I A T R Y | FL | |
| P S Y C H I A T R Y | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| Physician Assistant | FL | |
| Mental Health Counselor | FL |
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