Provider Demographics
NPI:1477894384
Name:SPENCER, JACQUELINE B (BS, MHA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:B
Last Name:SPENCER
Suffix:
Gender:F
Credentials:BS, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 T. LEIGH DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364
Mailing Address - Country:US
Mailing Address - Phone:985-360-6271
Mailing Address - Fax:
Practice Address - Street 1:249 T. LEIGH DRIVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364
Practice Address - Country:US
Practice Address - Phone:985-360-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No347C00000XTransportation ServicesPrivate Vehicle