Provider Demographics
NPI:1801380555
Name:THOMAS, JAILLA
Entity Type:Individual
Prefix:
First Name:JAILLA
Middle Name:
Last Name:THOMAS
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 1:5310 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:DARROW
Mailing Address - State:LA
Mailing Address - Zip Code:70725-2503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201 N I 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-214-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011405508106S00000X
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician