1982064101 NPI number — MRS. JESSICA S. AUSTON-POPO MS, LPC

Table of content: MRS. JESSICA S. AUSTON-POPO MS, LPC (NPI 1982064101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982064101 NPI number — MRS. JESSICA S. AUSTON-POPO MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSTON-POPO
Provider First Name:
JESSICA
Provider Middle Name:
S.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACKSON
Provider Other First Name:
JESSICA
Provider Other Middle Name:
S.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PLPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982064101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
714 NORTH WASHINGTON STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BASTROP
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-814-8801
Provider Business Mailing Address Fax Number:
318-300-1169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
714 NORTH WASHINGTON STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-814-8801
Provider Business Practice Location Address Fax Number:
318-300-1169
Provider Enumeration Date:
03/01/2016

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 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 6236 , 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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