Healthcare Provider Details

I. General information

NPI: 1245507821
Provider Name (Legal Business Name): JMJ PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2011
Last Update Date: 12/12/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N 4TH ST STE 100
BATON ROUGE LA
70802-5523
US

IV. Provider business mailing address

7725 HANKS DR
BATON ROUGE LA
70812-4004
US

V. Phone/Fax

Practice location:
  • Phone: 225-719-1988
  • Fax: 888-719-5854
Mailing address:
  • Phone: 225-719-1988
  • Fax: 888-719-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number773
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MAXINE ELIZABETH CAMPBELL
Title or Position: OWNER
Credential: PHD
Phone: 225-719-1988