Active NPI
Jaquita Gwynn Jordan, M.A., L.P.C.
- Mental Health Counselor
- Leesville, LA
National Provider Identifier
1649311549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 3044
- Practice address
- 300 S 4TH St
Leesville, LA 71446-4318 - Phone
- (337) 424-7406
- NPI assigned
- Feb 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3044 | LA | Primary |
Addresses
Primary practice location
300 S 4TH St
Leesville, LA 71446-4318
Mailing address
PO Box 431
New Llano, LA 71461-0431
Phone (337) 424-7406
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3044 | LA | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312416000000",
"number": "1649311549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 431",
"city": "NEW LLANO",
"state": "LA",
"postal_code": "714610431",
"telephone_number": "337-424-7406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 S 4TH ST",
"city": "LEESVILLE",
"state": "LA",
"postal_code": "714464318",
"telephone_number": "337-424-7406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "JAQUITA",
"middle_name": "GWYNN",
"name_prefix": "Ms.",
"credential": "M.A., L.P.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-12",
"last_updated": "2011-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "LA",
"license": "3044",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.