Healthcare Provider Details

I. General information

NPI: 1750176046
Provider Name (Legal Business Name): JESEKA MONISE HOLLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 RUE DE LAPLACE
BATON ROUGE LA
70810-4560
US

IV. Provider business mailing address

537 RUE DE LAPLACE
BATON ROUGE LA
70810-4560
US

V. Phone/Fax

Practice location:
  • Phone: 562-481-8752
  • Fax:
Mailing address:
  • Phone: 562-481-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC10642
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: