Healthcare Provider Details

I. General information

NPI: 1972290153
Provider Name (Legal Business Name): JESSICA DAVIS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 CANAL ST APT 1
NEW ORLEANS LA
70119-6249
US

IV. Provider business mailing address

3221 BEHRMAN PL STE 201
NEW ORLEANS LA
70114-8204
US

V. Phone/Fax

Practice location:
  • Phone: 504-644-2575
  • Fax: 504-644-2803
Mailing address:
  • Phone: 504-263-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC11218
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: