Provider Demographics
NPI:1144692716
Name:WILLIAMS, JAZARE (LPC)
Entity type:Individual
Prefix:
First Name:JAZARE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15580 GEORGE ONEAL RD
Mailing Address - Street 2:APT 1414
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-0503
Mailing Address - Country:US
Mailing Address - Phone:225-603-3959
Mailing Address - Fax:
Practice Address - Street 1:15580 GEORGE ONEAL RD
Practice Address - Street 2:APT 1414
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-0503
Practice Address - Country:US
Practice Address - Phone:225-603-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5199101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health