Healthcare Provider Details

I. General information

NPI: 1669909446
Provider Name (Legal Business Name): JENIFER LEVINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WRIGHT AVE STE D
CROWLEY LA
70526
US

IV. Provider business mailing address

1308 GRACELAND AVE
ABBEVILLE LA
70510-3844
US

V. Phone/Fax

Practice location:
  • Phone: 337-514-5180
  • Fax:
Mailing address:
  • Phone: 337-442-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8847
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT1449
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: