Healthcare Provider Details

I. General information

NPI: 1356870703
Provider Name (Legal Business Name): JEANETTE MICHELLE EDMONDS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42334 DELUXE PLZ STE 2
HAMMOND LA
70403-1237
US

IV. Provider business mailing address

42334 DELUXE PLZ STE 2
HAMMOND LA
70403-1237
US

V. Phone/Fax

Practice location:
  • Phone: 985-662-5520
  • Fax:
Mailing address:
  • Phone: 985-662-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1592
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number349453
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: