Healthcare Provider Details

I. General information

NPI: 1801456868
Provider Name (Legal Business Name): JENNY PEARL CROWE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 ROBERT BLVD
SLIDELL LA
70458-1355
US

IV. Provider business mailing address

37441 GUM CREEK RD
PEARL RIVER LA
70452-6422
US

V. Phone/Fax

Practice location:
  • Phone: 985-966-1998
  • Fax:
Mailing address:
  • Phone: 985-640-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4338
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4338
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: