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General NPI Number Information
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NPI Number | 1275651739
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Entity Type | Individual
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Provider Name | JILL FISK PEYTON MED LPC LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 2701 TRANSCONTINENTAL DR
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City | METAIRIE
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State | LA
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Zip | 70006
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Country | US
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Telephone | 504-885-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 71 GLENWOOD AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70123
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Country | US
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Telephone | 504-259-0922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2381
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT100
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License Number State | LA
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