Healthcare Provider Details

I. General information

NPI: 1225961782
Provider Name (Legal Business Name): JCM PRIVATE PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 AIRLINE HWY STE 203
BATON ROUGE LA
70816-8171
US

IV. Provider business mailing address

9800 AIRLINE HWY STE 203
BATON ROUGE LA
70816-8171
US

V. Phone/Fax

Practice location:
  • Phone: 225-229-0504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JACI MOSBY
Title or Position: OWNER
Credential: LPC
Phone: 225-432-2451