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DAVAUGHN Y JACKSON LPC
NPI 1821307547
Counselor - Professional in Saint Louis, MO

Active since September 29, 2010PECOS Enrolled
3800 S BROADWAY, SAINT LOUIS, MO 63118(314) 772-2205(314) 772-9264 Get Directions Write a Review

NPPES record last updated: September 29, 2010. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Davaughn Y Jackson Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DAVAUGHN Y JACKSON LPC (NPI 1821307547) is an individual professional provider in Saint Louis, Missouri, licensed in Missouri (2009022179) and active in the NPI registry since September 2010. She is enrolled in Medicare PECOS and is a graduate of Other (2003).

NPPES Registry Identity

NPI1821307547
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameDAVAUGHN Y JACKSONCredential: LPC
Location Address3800 S BROADWAYSaint Louis, MO 63118-4608
Mailing Address900 E Laharpe StKirksville, MO 63501-4520 · (660) 665-1962 · Fax (660) 665-3989
Phone(314) 772-2205
Fax(314) 772-9264
Sole ProprietorNo
Medical School CMSOtherGraduated 2003
Enumeration DateSeptember 29, 2010
✔ NPI 1821307547 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in MO · 2009022179
3800 S BROADWAY, Saint Louis, MO 63118
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Medica.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Davaughn Y Jackson Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3678010634
PECOS Enrollment IDI20260630000134
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Davaughn Jackson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Vitae Health Medical Illinois, PLLC
272 mi
Internal Medicine
3450 OAKTON ST
Skokie, IL 60076
  • Reassigned Medicare billing, Illinois enrollment
  • 491 clinicians in this Medicare group
NPI 1174013452 (224) 777-8034
Grow Healthcare Group PA
1,059 mi
Mental Health
66 W FLAGLER ST STE 900
Miami, FL 33130
  • Reassigned Medicare billing, Illinois and Missouri enrollments
  • 581 clinicians in this Medicare group
NPI 1245845932 (786) 244-7711

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TRACY LYNN CROPPER RN
Registered Nurse
3800 S BROADWAY
SAINT LOUIS, MO 63118
St. Louis City (314) 772-2205
MAUREEN A DOWNS LMSW
Social Worker
3800 S BROADWAY
SAINT LOUIS, MO 63118
St. Louis City (314) 772-2205
PAUL E. NIEMOELLER LPC
Counselor (Professional)
3800 S BROADWAY
SAINT LOUIS, MO 63118
St. Louis City (314) 772-2205
BRIANA C ALLEN
Registered Nurse
3800 S BROADWAY
SAINT LOUIS, MO 63118
St. Louis City (314) 772-2205
MATTHEW WILLIAM VAPOREAN LMSW
Social Worker
3800 S BROADWAY
SAINT LOUIS, MO 63118
St. Louis City (314) 772-2205
JOSEPH MOKWA
Counselor (Professional)
3800 S BROADWAY
SAINT LOUIS, MO 63118
St. Louis City (314) 772-2205
LACRESCHIA HAIRSTON LPN
Licensed Practical Nurse
3800 S BROADWAY
SAINT LOUIS, MO 63118
St. Louis City (314) 772-2205
TEMEAKA S BORUM RN
Registered Nurse
3800 S BROADWAY
SAINT LOUIS, MO 63118
St. Louis City (314) 772-2205

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Davaughn Jackson's NPI number?

The NPI number for Davaughn Jackson is 1821307547. It was assigned to this individual provider in the NPPES registry on September 29, 2010.

Where is Davaughn Jackson located?

Davaughn Jackson practices at 3800 S Broadway, Saint Louis, MO 63118. The listed phone number is (314) 772-2205.

What is Davaughn Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Davaughn Jackson enrolled in Medicare?

Yes. Davaughn Jackson is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Davaughn Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Davaughn Jackson reassigns Medicare benefits to 2 organizations: Vitae Health Medical Illinois, PLLC (Skokie, IL) and Grow Healthcare Group PA (Miami, FL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Davaughn Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Davaughn Jackson accept?

Health plans from Anthem Blue Cross and Blue Shield and Medica list Davaughn Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Davaughn Jackson was last updated on September 29, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.