Healthcare Provider Details

I. General information

NPI: 1134880560
Provider Name (Legal Business Name): JILL TALBOT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 RUE COLETTE
THIBODAUX LA
70301-5628
US

IV. Provider business mailing address

259 DONALD DR
THIBODAUX LA
70301-6971
US

V. Phone/Fax

Practice location:
  • Phone: 985-625-0023
  • Fax: 985-625-0022
Mailing address:
  • Phone: 985-803-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7683
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: