Basic Information
| Provider Information | |||||||||
| NPI: | 1023577251 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIKE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | CAMILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102B W BAYOU ST | ||||||||
| Address2: | |||||||||
| City: | FARMERVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712412802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183682300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 102B W BAYOU ST | ||||||||
| Address2: | |||||||||
| City: | FARMERVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712412802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183682300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2019 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.