Healthcare Provider Details

I. General information

NPI: 1558957365
Provider Name (Legal Business Name): JENAE ARMANI RICHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 TRACIE DR
LEESVILLE LA
71446-5548
US

IV. Provider business mailing address

167 TRACIE DR
LEESVILLE LA
71446-5548
US

V. Phone/Fax

Practice location:
  • Phone: 719-289-2449
  • Fax:
Mailing address:
  • Phone: 719-289-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC11205
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC11205
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: