BROOKE P JACKSON PSYCHOLOGIST — NPI 1144838913 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1144838913

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103TC0700X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical

Box 32 Service Location & ZIP+4

1044 SIR FRANCIS DRAKE BLVD STE 1, KENTFIELD, CA, 94904-1454

✓ 9-Digit EDI 837 ZIP+4 (94904-1454)

Practice Phone & Referral Fax

(415) 609-2361

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1144838913 (BROOKE P JACKSON PSYCHOLOGIST) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1144838913` (NPI-2 Organization / Facility)
Provider / Legal Name	BROOKE P JACKSON PSYCHOLOGIST
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical NUCC Code: `103TC0700X` (Psychologist, Clinical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1044 SIR FRANCIS DRAKE BLVD STE 1, KENTFIELD, CA, 94904-1454
Practice Telephone / Fax	Tel: (415) 609-2361
Administrative Mailing Address	1044 SIR FRANCIS DRAKE BLVD STE 1, KENTFIELD, CA, 94904-1454
Enumeration & Last Sync	Enumerated: 2020-07-17 \| CMS Record Updated: 2020-07-17
Authorized Official	BROOKE JACKSON (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1044 SIR FRANCIS DRAKE BLVD STE 1, KENTFIELD, CA, 94904-1454

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Plain-English Taxonomy & CMS Crosswalk (103TC0700X)

What Does Taxonomy Code 103TC0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TC0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical) • CMS Code 68 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Clinical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BROOKE P JACKSON PSYCHOLOGIST)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`103TC0700X` — Psychologist, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BROOKE P JACKSON PSYCHOLOGIST (NPI #1144838913)