MEDICARE: MRS. PATRICE PARKER JEFFERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	9377	LA
2	171M00000X	Case Manager/Care Coordinator	9377	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346525367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICE PARKER JEFFERSON

Provider Business Mailing Address
First Line	:	3330 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6206
Country	:	US
Telephone Number	:	504-827-2701
Fax Number	:	504-827-2715

Provider Business Practice Location Address
First Line	:	3330 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6206
Country	:	US
Telephone Number	:	504-827-2701
Fax Number	:	504-827-2714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	12/17/2018

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