Healthcare Provider Details

I. General information

NPI: 1689232571
Provider Name (Legal Business Name): JIRA COURTNEY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 PENISTON ST
NEW ORLEANS LA
70115-5851
US

IV. Provider business mailing address

2328 PENISTON ST
NEW ORLEANS LA
70115-5851
US

V. Phone/Fax

Practice location:
  • Phone: 504-994-3153
  • Fax:
Mailing address:
  • Phone: 504-994-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7965
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: