Healthcare Provider Details

I. General information

NPI: 1710309216
Provider Name (Legal Business Name): JMJ PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N 4TH ST SUITE 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:
Mailing address:
  • Phone: 225-719-1988
  • Fax: 888-719-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.000028
License Number StateLA

VIII. Authorized Official

Name: MAXINE CAMPBELL-FLINT
Title or Position: MEDICAL PSYCHOLOGIST
Credential: MP, PHD
Phone: 225-719-1988