Healthcare Provider Details

I. General information

NPI: 1538769252
Provider Name (Legal Business Name): JACI CIARA MOSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S SHERWOOD FOREST BLVD STE 201
BATON ROUGE LA
70816-2261
US

IV. Provider business mailing address

3535 S SHERWOOD FOREST BLVD STE 201
BATON ROUGE LA
70816-2261
US

V. Phone/Fax

Practice location:
  • Phone: 225-432-2451
  • Fax:
Mailing address:
  • Phone: 225-432-2451
  • Fax: 225-495-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9989
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: