Healthcare Provider Details

I. General information

NPI: 1902462724
Provider Name (Legal Business Name): CHELSEA JE'NAE WYATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
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: 318-314-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8711
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: