Provider Demographics
NPI:1407459142
Name:PAVY, JESSICA LIGHTSEY (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LIGHTSEY
Last Name:PAVY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7317
Mailing Address - Country:US
Mailing Address - Phone:225-505-0163
Mailing Address - Fax:
Practice Address - Street 1:10500 SAM RUSHING RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2000
Practice Address - Country:US
Practice Address - Phone:225-505-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3911101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional