Provider Demographics
NPI:1255786844
Name:BACH, JENNIFER CAITLIN (MS, NCC, PLPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CAITLIN
Last Name:BACH
Suffix:
Gender:F
Credentials:MS, NCC, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SAWMILL RD
Mailing Address - Street 2:APARTMENT 17-103
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5902
Mailing Address - Country:US
Mailing Address - Phone:251-406-0185
Mailing Address - Fax:
Practice Address - Street 1:3616 S I 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1874
Practice Address - Country:US
Practice Address - Phone:504-838-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health