Healthcare Provider Details

I. General information

NPI: 1992088454
Provider Name (Legal Business Name): JENNY PREJEAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD STE 100
LAFAYETTE LA
70503-2636
US

IV. Provider business mailing address

PO BOX 62600 DEPT 1721
NEW ORLEANS LA
70162-2600
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-8400
  • Fax: 337-289-8401
Mailing address:
  • Phone: 337-706-1605
  • Fax: 337-981-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4532
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: