Healthcare Provider Details

I. General information

NPI: 1003291717
Provider Name (Legal Business Name): JESSICA O'CONNOR-RATHBUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19514 HWY 190 STE A
ALBANY LA
70711
US

IV. Provider business mailing address

2450 BRUSH CREEK CT
ZACHARY LA
70791-2889
US

V. Phone/Fax

Practice location:
  • Phone: 617-869-9843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: