Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Kurt H Jackson

Individual provider Professional Counselor · NPI 1104178649

Mr. Kurt H Jackson is a Mental Health Counselor in Chicago, Illinois. Qualified in 2006, 20 years ago. Practices with Blue Moon Senior Counseling of Illinois LLC, a 31-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Illinois.

Years since qualifying
20
Licensed in
IL
In the registry since
2012
Specialties on file
2
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Practice location Address checks out

8044 S Racine Ave
Chicago, IL 60620-3011
Phone: (773) 723-9291
Fax: (773) 723-9291
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 180015933 (IL)
Professional Counselor Taxonomy 101YP2500X · Licence 178006138 (IL)

Record details

NPI number1104178649
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 8, 2012
Last updated in NPPESOctober 9, 2024
Certification dateOctober 9, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Blue Moon Senior Counseling Of Illinois Llc — 31 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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