Healthcare Provider Details

I. General information

NPI: 1679465124
Provider Name (Legal Business Name): JESSIE LOUIS-JEAN, MS, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 E OLD COUNTRY RD STE 6
HICKSVILLE NY
11801-4292
US

IV. Provider business mailing address

1383 PETERS BLVD
BAY SHORE NY
11706-4847
US

V. Phone/Fax

Practice location:
  • Phone: 646-856-9151
  • Fax: 631-614-5642
Mailing address:
  • Phone: 646-856-9151
  • Fax: 631-614-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JESSIE M LOUIS JEAN
Title or Position: OWNER
Credential: LMHC
Phone: 646-856-9151