Healthcare Provider Details

I. General information

NPI: 1881653665
Provider Name (Legal Business Name): JEANNE WOLF L.P.C.,L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 4TH AVE 150
LAKE CHARLES LA
70601-7887
US

IV. Provider business mailing address

2829 4TH AVE 150
LAKE CHARLES LA
70601-7887
US

V. Phone/Fax

Practice location:
  • Phone: 337-480-7800
  • Fax: 337-474-4552
Mailing address:
  • Phone: 337-480-7805
  • Fax: 337-474-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2873
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number843
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: