Destiny Jackson, M.A., PLPC, PLMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3341 Youree Dr
101
Shreveport, LA 71105-2149

Phone

(318) 219-4171

NPI assigned

Sep 7, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Azalea Health ServicesGroup PAC ID 8628432028, 41 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Azalea Health Services

  • Clinical Social Worker
  • Lafayette, LA
  • NPI 1043999170
  Medicare reassignment Care Compare group NPD
• Azalea Health Services Texas LLC

  • Clinical Social Worker
  • New Braunfels, TX
  • NPI 1326871807
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1184171100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6129 WINCANTON DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711293908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3341 YOUREE DR",
            "address_2": "101",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052149",
            "telephone_number": "318-219-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DESTINY",
        "credential": "M.A., PLPC, PLMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clarke Jackson
• Dana Jackson
• Dana M Jackson, D.D.S.
• Dannisha Jackson, MHS
• Deaquanita Shehalorenza Jackson
• Destiny Jackson
• Dijuan Jackson
• Flora A Jackson
• Frederick J Jackson Jr., MS.
• Jacqueline Lynn Jackson, PROVIDE CARE

• Mental Health Counselor in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Mental Health Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.