Provider Demographics
NPI:1558500496
Name:BESS, JENNIFER ALISON (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALISON
Last Name:BESS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6642 OLD BATON ROUGE HWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-9331
Mailing Address - Country:US
Mailing Address - Phone:217-725-4244
Mailing Address - Fax:
Practice Address - Street 1:243 CURTISS RD
Practice Address - Street 2:MENTAL HEALTH CLINIC
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2425
Practice Address - Country:US
Practice Address - Phone:318-456-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007469103TC0700X
TX33884103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical