Provider Demographics
NPI:1891187746
Name:JBL THERAPEUTIC CENTER, INC.
Entity Type:Organization
Organization Name:JBL THERAPEUTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:504-344-5651
Mailing Address - Street 1:1799 STUMPF BLVD
Mailing Address - Street 2:BUILDING 4, SUITE 5
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3950
Mailing Address - Country:US
Mailing Address - Phone:504-344-5651
Mailing Address - Fax:504-373-5474
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:BUILDING 4, SUITE 5
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:504-344-5651
Practice Address - Fax:504-373-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty