Provider Demographics
NPI:1497981153
Name:JAY, LINDSAY AVENT (NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:AVENT
Last Name:JAY
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:CHERRYL
Other - Last Name:AVENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 W WOODROW WILSON AVE
Mailing Address - Street 2:JACKSON MEDICAL MALL CLINIC 9
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7681
Mailing Address - Country:US
Mailing Address - Phone:601-984-5836
Mailing Address - Fax:601-815-8708
Practice Address - Street 1:350 W WOODROW WILSON AVE
Practice Address - Street 2:JACKSON MEDICAL MALL CLINIC 9
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7681
Practice Address - Country:US
Practice Address - Phone:601-984-5836
Practice Address - Fax:601-815-8708
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02438563Medicaid