Healthcare Provider Details

I. General information

NPI: 1477367100
Provider Name (Legal Business Name): JILL ANNE GOMEZ LPC, NCC, NCSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 LORINO ST
METAIRIE LA
70006-2323
US

IV. Provider business mailing address

3714 BARBARA PL
METAIRIE LA
70002-5806
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-3015
  • Fax: 504-454-5803
Mailing address:
  • Phone: 504-512-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2598
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: