Healthcare Provider Details

I. General information

NPI: 1134665813
Provider Name (Legal Business Name): MARK JOHNSON OAKES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 S I 10 SERVICE RD W STE 215
METAIRIE LA
70001-7436
US

IV. Provider business mailing address

200 S BROAD ST STE 7
NEW ORLEANS LA
70119-6447
US

V. Phone/Fax

Practice location:
  • Phone: 504-301-9990
  • Fax:
Mailing address:
  • Phone: 504-309-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7250
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: