Provider Demographics
NPI:1144714510
Name:JILES, GIOVHANNI (CIT)
Entity type:Individual
Prefix:MR
First Name:GIOVHANNI
Middle Name:
Last Name:JILES
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N 31ST ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3959
Mailing Address - Country:US
Mailing Address - Phone:318-737-7794
Mailing Address - Fax:
Practice Address - Street 1:2321 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-9366
Practice Address - Country:US
Practice Address - Phone:318-600-3333
Practice Address - Fax:318-600-3334
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
LACIT-5317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator