Provider Demographics
NPI:1538675459
Name:SKJ PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:SKJ PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, PMHNP, LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:225-278-3541
Mailing Address - Street 1:16510 BUTTERNUT CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-6553
Mailing Address - Country:US
Mailing Address - Phone:225-278-3541
Mailing Address - Fax:
Practice Address - Street 1:8280 YMCA PLAZA DR BLDG 10B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0929
Practice Address - Country:US
Practice Address - Phone:225-341-4147
Practice Address - Fax:225-755-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09208261QM0850X, 261QM0855X
LALPC4199261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health