Jade Raven Jackson

Primary specialty

CounselorTaxonomy code 101Y00000X

License

PLC11226 Issued in LA

Practice address

720 Saint John St
Lafayette, LA 70501-6706

Phone

(337) 237-2090

NPI assigned

May 19, 2026

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 names 1

• Mrs. Jade Raven Prevot Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• The Extra Mile, Region IV, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Scott, LA
  • NPI 1154016475
  NPD (past)
• The Extra Mile, Region IV, Inc.

  • Community/Behavioral Health Agency
  • Lafayette, LA
  • NPI 1962777268
  NPD (past)

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

{
    "created_epoch": "1779148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1871423384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MANN DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705061621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 SAINT JOHN ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705016706",
            "telephone_number": "337-237-2090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JADE",
        "middle_name": "RAVEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-05-19",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "LA",
            "license": "PLC11226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JADE",
            "last_name": "PREVOT",
            "middle_name": "RAVEN",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lafonda M Jacko
• Angel Heart Jackson, LMSW
• Avis Jackson
• Celeste Keys Jackson
• Jacob Lane Jackson, PT, DPT
• Jared Jackson
• Jennifer Jackson, R.D.
• Marcko Jackson
• Matthew Jackson
• Melvin Jackson III, PD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2026; 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.