Provider Demographics
NPI:1306405071
Name:RUSH, JENNIFER (LPC-S, LMFT-SC, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RUSH
Suffix:
Gender:F
Credentials:LPC-S, LMFT-SC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PARK PL STE 204I
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6100
Mailing Address - Country:US
Mailing Address - Phone:225-954-0277
Mailing Address - Fax:
Practice Address - Street 1:106 PARK PL STE 204I
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6100
Practice Address - Country:US
Practice Address - Phone:225-954-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5534101YP2500X
LA1213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3892596Medicaid
LA5534OtherSTATE - LICENSED PROFESSIONAL COUNSELOR
LA3892600Medicaid
LA1213OtherLICENSED MARRIAGE AND FAMILY THERAPIST