Provider Demographics
NPI:1902677941
Name:MIZELL, JESSICA (PLPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MIZELL
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4852
Mailing Address - Country:US
Mailing Address - Phone:601-316-1784
Mailing Address - Fax:
Practice Address - Street 1:4300 S I 10 SERVICE RD W STE 103Q
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7411
Practice Address - Country:US
Practice Address - Phone:985-239-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty