Provider Demographics
NPI:1265001481
Name:LOUIS-JEAN, JESSIE M (MS, LMHC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:M
Last Name:LOUIS-JEAN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:M
Other - Last Name:LOUIS-JEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1383 PETERS BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4847
Mailing Address - Country:US
Mailing Address - Phone:347-382-5239
Mailing Address - Fax:
Practice Address - Street 1:1383 PETERS BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4847
Practice Address - Country:US
Practice Address - Phone:347-382-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014478101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health