Lavonne Jackson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

18659 Issued in FL

Practice address

622 S Betty LN Apt 2
Clearwater, FL 33756-6080

Phone

(757) 769-9056

NPI assigned

Apr 6, 2020

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1316576937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7215",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337587215",
            "telephone_number": "757-769-9056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 S BETTY LN APT 2",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337566080",
            "telephone_number": "757-769-9056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAVONNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "18659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTER MENTAL HEALTH COUNSELOR INTER",
            "identifier": "18659",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ljackson@iescm.org",
            "affiliation": "N",
            "endpointDescription": "Organization's secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "622 S Betty Ln Apt 2",
            "city": "Clearwater",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337566080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• April Marie Jackson, ARNP
• James William Jackson III, D.D.S.
• Kellie Lyn Jackson, PTA
• Kim Jackson
• Lavett Jackson
• Lawanda Bevel Jackson, APRN
• Mackenzie Jackson
• Shanel Loree Jackson, P.T.
• Dominique Leticia Jacobs
• Stephen H Jacobs, MD

• Mental Health Counselor in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.