MEDICARE: MR. JIMMY A SNOW JR. LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3814	LA

General Provider Information

NPI Number	:	1841595337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JIMMY A SNOW JR. LPC

Provider Business Mailing Address
First Line	:	902 DEVILLE LN
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-6313
Country	:	US
Telephone Number	:	318-255-5753
Fax Number	:	318-242-4698

Provider Business Practice Location Address
First Line	:	902 DEVILLE LN
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-6313
Country	:	US
Telephone Number	:	318-255-5753
Fax Number	:	318-242-4698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2011
Last Update Date	:	10/09/2014

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