Healthcare Provider Details

I. General information

NPI: 1205996360
Provider Name (Legal Business Name): JIZETTE MONTRISE HALL M.A., LPC, LMFT, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15654 SUMMERWOOD AVE
BATON ROUGE LA
70817-1547
US

IV. Provider business mailing address

15654 SUMMERWOOD AVE
BATON ROUGE LA
70817-1547
US

V. Phone/Fax

Practice location:
  • Phone: 985-414-2754
  • Fax: 504-226-0786
Mailing address:
  • Phone: 985-414-2754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2376
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number234
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: