Basic Information
| Provider Information | |||||||||
| NPI: | 1780722926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | KHOURY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4105 KIRKMAN ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706074603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374758022 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4105 KIRKMAN ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706074603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374758022 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7158 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.