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General NPI Number Information
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NPI Number | 1811124860
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Entity Type | Individual
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Provider Name | JENISE NATE AYDELL-HONTIVEROS LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 11990 JACKSON ST
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City | CLINTON
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State | LA
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Zip | 70722-3210
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Country | US
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Telephone | 225-683-5292
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Fax | 225-683-1310
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Provider Business Mailing Address
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Address Line | 25623 MELANIE CIR
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City | AMITE
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State | LA
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Zip | 70422-5474
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Country | US
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Telephone | 855-517-7089
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Fax | 225-529-9939
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 9861
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9861
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License Number State | LA
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