Provider Demographics
NPI:1164447561
Name:MAY, JEWEL M (MA, LAC)
Entity Type:Individual
Prefix:MS
First Name:JEWEL
Middle Name:M
Last Name:MAY
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2346
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-2346
Mailing Address - Country:US
Mailing Address - Phone:318-283-0868
Mailing Address - Fax:318-283-0875
Practice Address - Street 1:320 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4539
Practice Address - Country:US
Practice Address - Phone:318-283-0868
Practice Address - Fax:318-283-0875
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA836101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)