Provider Demographics
NPI:1992214175
Name:CELIUS-WASHINGTON, JENNIFER LOUISE (MHS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LOUISE
Last Name:CELIUS-WASHINGTON
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 MACARTHUR BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6871
Mailing Address - Country:US
Mailing Address - Phone:504-535-3210
Mailing Address - Fax:
Practice Address - Street 1:3630 MACARTHUR BLVD STE C
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6871
Practice Address - Country:US
Practice Address - Phone:504-535-3210
Practice Address - Fax:504-484-0555
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA011405307OtherDRIVER LICENSE NUMBER