Avis Jackson

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PLC8960 Issued in LA

Practice address

315 S College Rd
Lafayette, LA 70503-3212

Phone

(337) 572-9844

NPI assigned

Feb 12, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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": "1581465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1770115206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9487 BROOKLINE AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708091429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 S COLLEGE RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033212",
            "telephone_number": "337-572-9844"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "28446 Gray Eagle Dr",
            "address_purpose": "LOCATION",
            "city": "Denham Springs",
            "state": "LA",
            "postal_code": "707267876",
            "country_code": "US",
            "telephone_number": "225-998-5372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AVIS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-12",
        "last_updated": "2024-06-07",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "PLC8960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J & J RX Network LLC
• J Patrick Herrington MD LTD
• J. Provost LLC (a Professional Chiropractic Corporation)
• Lafonda M Jacko
• Angel Heart Jackson, LMSW
• Celeste Keys Jackson
• Jacob Lane Jackson, PT, DPT
• Jade Raven Jackson
• Jared Jackson
• Jennifer Jackson, R.D.

• Professional Counselor in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Professional Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; 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.