Healthcare Provider Details

I. General information

NPI: 1902677941
Provider Name (Legal Business Name): JESSICA MIZELL PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 S I 10 SERVICE RD W STE 103Q
METAIRIE LA
70001-7411
US

IV. Provider business mailing address

2402 JASMINE ST
NEW ORLEANS LA
70122-4852
US

V. Phone/Fax

Practice location:
  • Phone: 985-239-1020
  • Fax:
Mailing address:
  • Phone: 601-316-1784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC10003
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: