Provider Demographics
NPI:1962858191
Name:WEBB, JEMEEL LATRICE
Entity Type:Individual
Prefix:
First Name:JEMEEL
Middle Name:LATRICE
Last Name:WEBB
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 1:1787 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2045
Mailing Address - Country:US
Mailing Address - Phone:318-218-9538
Mailing Address - Fax:
Practice Address - Street 1:1787 SOUTHVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112
Practice Address - Country:US
Practice Address - Phone:318-218-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7770001884368704Medicaid