Provider Demographics
NPI:1598240368
Name:SCALLION, JESSIKA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:ANN
Last Name:SCALLION
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BEACON BEHAVIORAL OUTPATIENT BOGALUSA
Mailing Address - Street 2:1640 SOUTH COLUMBIA
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427
Mailing Address - Country:US
Mailing Address - Phone:985-735-1750
Mailing Address - Fax:985-735-1752
Practice Address - Street 1:1640 S COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-5800
Practice Address - Country:US
Practice Address - Phone:985-735-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty