Healthcare Provider Details

I. General information

NPI: 1295204667
Provider Name (Legal Business Name): JAMAL D GIPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 CENTRAL AVE
MONROE LA
71203-6156
US

IV. Provider business mailing address

511 STERLINGTON HWY
FARMERVILLE LA
71241-3122
US

V. Phone/Fax

Practice location:
  • Phone: 318-340-1535
  • Fax: 318-340-1539
Mailing address:
  • Phone: 318-309-1449
  • Fax: 318-309-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5204
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8801
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: