Provider Demographics
NPI:1821755315
Name:NUSSBAUMER, JANETTE KAYE
Entity Type:Individual
Prefix:MRS
First Name:JANETTE
Middle Name:KAYE
Last Name:NUSSBAUMER
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 1:4021 WE HECK CT STE L1
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-0416
Mailing Address - Country:US
Mailing Address - Phone:225-412-7913
Mailing Address - Fax:
Practice Address - Street 1:4021 WE HECK CT STE L1
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0416
Practice Address - Country:US
Practice Address - Phone:225-412-7912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional