Healthcare Provider Details

I. General information

NPI: 1538675459
Provider Name (Legal Business Name): SKJ PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 YMCA PLAZA DR BLDG 10B
BATON ROUGE LA
70810-0929
US

IV. Provider business mailing address

16510 BUTTERNUT CT
BATON ROUGE LA
70817-6553
US

V. Phone/Fax

Practice location:
  • Phone: 225-341-4147
  • Fax: 225-755-1211
Mailing address:
  • Phone: 225-278-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLPC4199
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberAP09208
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLPC4199
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberAP09208
License Number StateLA

VIII. Authorized Official

Name: MS. SUZANNE JONES
Title or Position: APRN, PMHNP, LPC
Credential: APRN
Phone: 225-278-3541