Healthcare Provider Details

I. General information

NPI: 1982517082
Provider Name (Legal Business Name): JONATHAN DAVID WILCOX BA-PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9171 COCKERHAM RD STE 201
DENHAM SPRINGS LA
70726-2255
US

IV. Provider business mailing address

9171 COCKERHAM RD STE 201
DENHAM SPRINGS LA
70726-2255
US

V. Phone/Fax

Practice location:
  • Phone: 225-523-5124
  • Fax:
Mailing address:
  • Phone: 225-523-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6127
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: