Provider Demographics
NPI:1619408945
Name:SPENCER, JYTECA
Entity Type:Individual
Prefix:
First Name:JYTECA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 AIRLINE DR STE 211D
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6440
Mailing Address - Country:US
Mailing Address - Phone:504-731-1607
Mailing Address - Fax:
Practice Address - Street 1:7809 AIRLINE DR STE 211D
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6440
Practice Address - Country:US
Practice Address - Phone:504-731-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health