Healthcare Provider Details

I. General information

NPI: 1053513218
Provider Name (Legal Business Name): JENNIFER MARIE ISTRE MED., NCC,LPC,LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E. EDWARDS
RAYNE LA
70578
US

IV. Provider business mailing address

316 VICKSBURG RD
RAYNE LA
70578-7628
US

V. Phone/Fax

Practice location:
  • Phone: 337-412-5200
  • Fax:
Mailing address:
  • Phone: 337-412-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3323
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1093
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: