Healthcare Provider Details

I. General information

NPI: 1639812563
Provider Name (Legal Business Name): JHAZZMAN ELLIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JHAZZMAN MARTIN LCSW

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 TERRACE HILL DR
JONESBORO LA
71251-3031
US

IV. Provider business mailing address

352 TERRACE HILL DR
JONESBORO LA
71251-3031
US

V. Phone/Fax

Practice location:
  • Phone: 318-497-0846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14205
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: