Basic Information
Provider Information | |||||||||
NPI: | 1790232726 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JENKINS | ||||||||
FirstName: | DANIELLE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3345 PLAZA DR | ||||||||
Address2: |   | ||||||||
City: | CHALMETTE | ||||||||
State: | LA | ||||||||
PostalCode: | 700432421 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9036914650 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 200 RUE JONATHAN | ||||||||
Address2: |   | ||||||||
City: | SLIDELL | ||||||||
State: | LA | ||||||||
PostalCode: | 704615438 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5043193103 | ||||||||
FaxNumber: | 5043240464 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/07/2016 | ||||||||
LastUpdateDate: | 09/07/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.