Clark, Jessica

Clark, Jessica is an individual health care provider with primary practice located at 42189 Shadow Creek Ave , Gonzales LA 70737-7241. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Counselor. Behavioral Health & Social Service Providers / Counselor is her primary health care specialty. Clark, Jessica can be contacted via phone (225) 978-7583.

Contact Information

Primary practice address
42189 Shadow Creek Ave Gonzales LA 70737-7241
Phone: (225) 978-7583
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1811416076
LBN Legal business name Clark, Jessica
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 19th, 2017
Last updated Jul 21st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811416076 NPPES
Louisiana MEDICAID 0000

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