Healthcare Provider Details

I. General information

NPI: 1295291532
Provider Name (Legal Business Name): JESSICA G DAVIES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CIVIC CENTER BLVD
HOUMA LA
70360-5937
US

IV. Provider business mailing address

10 AMARILLO DR
HOUMA LA
70360-7285
US

V. Phone/Fax

Practice location:
  • Phone: 985-333-2020
  • Fax:
Mailing address:
  • Phone: 985-856-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4227
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: