Healthcare Provider Details

I. General information

NPI: 1306207253
Provider Name (Legal Business Name): JEFFERSON OAKS PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8318 JEFFERSON HWY STE. A
BATON ROUGE LA
70809-0800
US

IV. Provider business mailing address

8318 JEFFERSON HWY STE. A
BATON ROUGE LA
70809-0800
US

V. Phone/Fax

Practice location:
  • Phone: 225-927-5624
  • Fax: 225-927-5611
Mailing address:
  • Phone: 225-927-5624
  • Fax: 225-927-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberBH0007833
License Number StateLA

VIII. Authorized Official

Name: CHERYL J DOUB
Title or Position: CEO
Credential: LCSW
Phone: 225-927-5624