Provider Demographics
NPI:1588613673
Name:ZACHRY, JENNIFER H (MED)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:H
Last Name:ZACHRY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CYPRESS CV
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5143
Mailing Address - Country:US
Mailing Address - Phone:337-857-8375
Mailing Address - Fax:337-856-1822
Practice Address - Street 1:3 FLAGG PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7003
Practice Address - Country:US
Practice Address - Phone:337-857-8375
Practice Address - Fax:337-856-1822
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA890101YA0400X
LA2015101YM0800X
LA458106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist