Healthcare Provider Details

I. General information

NPI: 1609308402
Provider Name (Legal Business Name): NATALIE JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 FERRAND ST STE 1
MONROE LA
71201-3255
US

IV. Provider business mailing address

2414 FERRAND ST STE 1
MONROE LA
71201-3255
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-0072
  • Fax: 318-325-0070
Mailing address:
  • Phone: 318-325-0072
  • Fax: 318-325-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5731
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: