Provider Demographics
NPI:1225496797
Name:GUILLORY, JESSICA (MS)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W HUTCHINSON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-4124
Mailing Address - Country:US
Mailing Address - Phone:337-207-5941
Mailing Address - Fax:
Practice Address - Street 1:1120 W HUTCHINSON AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4124
Practice Address - Country:US
Practice Address - Phone:337-250-4263
Practice Address - Fax:337-250-4263
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YM0800X
LA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)