Provider Demographics
NPI:1730746082
Name:EDMOND, JACQUELINE SCOTT
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SCOTT
Last Name:EDMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:SCOTT
Other - Last Name:EDMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:13541 TRAPPERS CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2804
Mailing Address - Country:US
Mailing Address - Phone:504-237-7036
Mailing Address - Fax:504-245-2796
Practice Address - Street 1:13541 TRAPPERS CT
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2804
Practice Address - Country:US
Practice Address - Phone:504-237-7036
Practice Address - Fax:504-245-2796
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2855101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty