DR. JACOB JERRY JACKSON (PHD, LMHC, CADC) – Mental Health Counselor, NPI 1003366329
Mental Health Counselor
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
630 MENTAL HEALTH COUNSELOR in IA
Provider Addresses for DR. JACOB JERRY JACKSON (PHD, LMHC, CADC)
180 10TH ST SE STE 201
LE MARS, IA 510312557
Phone: (712) 546-4624
Fax: (712) 546-9395
Type: Location
1700, Helmer Street, Sioux City, Woodbury County, Iowa, 51103, United States
SIOUX CITY, IA 511032834
Phone: (712) 223-1082
Type: Mailing
180 10TH ST SE
LE MARS, IA 510312559
Phone: (712) 499-0207
Type: Mailing
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: 2023-12-05
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 |
|---|---|---|---|---|
| I20231205003305 | I | Mental Health Counselor | IA | 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 51031)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Mental Health Counselor | IA | |
| - | UT | |
| P S Y C H I A T R Y | IA | |
| Clinical Social Worker | IA | |
| - | IA | |
| Mental Health Counselor | IA | |
| Nurse Practitioner | IA | |
| Clinical Social Worker | IA | |
| Clinical Social Worker | IA | |
| Clinical Social Worker | IA |
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