Healthcare Provider Details

I. General information

NPI: 1982064101
Provider Name (Legal Business Name): JESSICA S. AUSTON-POPO MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA S. JACKSON PLPC

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 NORTH WASHINGTON STREET SUITE 100
BASTROP LA
71220
US

IV. Provider business mailing address

714 NORTH WASHINGTON STREET SUITE 100
BASTROP LA
71220
US

V. Phone/Fax

Practice location:
  • Phone: 318-814-8801
  • Fax: 318-300-1169
Mailing address:
  • Phone: 318-814-8801
  • Fax: 318-300-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6236
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: