Provider Demographics
NPI:1629441597
Name:JEFFERSON, MAURICE RASHAD
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:RASHAD
Last Name:JEFFERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5636
Mailing Address - Country:US
Mailing Address - Phone:504-239-6972
Mailing Address - Fax:
Practice Address - Street 1:10001 LAKE FOREST BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6200
Practice Address - Country:US
Practice Address - Phone:504-821-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health