Basic Information
| Provider Information | |||||||||
| NPI: | 1326419771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | HILDA | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | MHP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JONES | ||||||||
| OtherFirstName: | HILDA | ||||||||
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| OtherCredential: | MHP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2448 JOHNSTON ST STE B | ||||||||
| Address2: | 2448 JOHNSTON SUITE B | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372337250 | ||||||||
| FaxNumber: | 3372337104 | ||||||||
| Practice Location | |||||||||
| Address1: | 2448 JOHNSTON ST STE B | ||||||||
| Address2: | 2448 JOHNSTON SUITE B | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372337250 | ||||||||
| FaxNumber: | 3372337104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2015 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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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 | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 600720410 | 05 | LA | MEDICAID |