Healthcare Provider Details

I. General information

NPI: 1790330629
Provider Name (Legal Business Name): JAMILA ZAHRA ROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 GOODWOOD BLVD STE A1
BATON ROUGE LA
70806-7740
US

IV. Provider business mailing address

8211 GOODWOOD BLVD STE A1
BATON ROUGE LA
70806-7740
US

V. Phone/Fax

Practice location:
  • Phone: 225-431-1921
  • Fax:
Mailing address:
  • Phone: 225-431-1921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: