1184023905 NPI number — JESSICA COLLINS ST. PIERRE LCSW

Table of content: ELIZABETH NICOLE KNIPP (NPI 1972031409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184023905 NPI number — JESSICA COLLINS ST. PIERRE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ST. PIERRE
Provider First Name:
JESSICA
Provider Middle Name:
COLLINS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
JESSICA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184023905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 395
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70722-0395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-683-5292
Provider Business Mailing Address Fax Number:
225-683-3411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2810 E CAUSEWAY APPROACH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70448-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-875-2340
Provider Business Practice Location Address Fax Number:
985-875-2737
Provider Enumeration Date:
08/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  5286 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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