Provider Demographics
NPI:1457085250
Name:JEAN-LOUIS, THERESE JUDE
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:JUDE
Last Name:JEAN-LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16281 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4401
Mailing Address - Country:US
Mailing Address - Phone:754-244-8893
Mailing Address - Fax:
Practice Address - Street 1:16281 SW 23RD ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4401
Practice Address - Country:US
Practice Address - Phone:754-244-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-70068106S00000X
FL1-23-66722103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101532400Medicaid