Healthcare Provider Details

I. General information

NPI: 1841985991
Provider Name (Legal Business Name): JESSALYN MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 N 19TH ST
MONROE LA
71201-4554
US

IV. Provider business mailing address

224 FINKS HIDEAWAY RD APT 37
MONROE LA
71203-2391
US

V. Phone/Fax

Practice location:
  • Phone: 318-509-8073
  • Fax: 318-703-5765
Mailing address:
  • Phone: 731-426-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC9606
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberPLC9606
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC9606
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: