Healthcare Provider Details

I. General information

NPI: 1174996284
Provider Name (Legal Business Name): JESSI BOLTON EIDT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WASHINGTON ST STE 310
MONROE LA
71201-6761
US

IV. Provider business mailing address

300 WASHINGTON ST STE 310A
MONROE LA
71201-6761
US

V. Phone/Fax

Practice location:
  • Phone: 318-372-1810
  • Fax:
Mailing address:
  • Phone: 318-372-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1221
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5683
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: