Healthcare Provider Details

I. General information

NPI: 1124688643
Provider Name (Legal Business Name): TAMMY JONES LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12097 OLD HAMMOND HWY STE H
BATON ROUGE LA
70816-8679
US

IV. Provider business mailing address

9522 W CORONADO DR
BATON ROUGE LA
70815-8912
US

V. Phone/Fax

Practice location:
  • Phone: 225-421-1722
  • Fax:
Mailing address:
  • Phone: 225-364-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number828
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: