Provider Demographics
NPI:1265052476
Name:AMETHYST & ASSOCIATES LLC
Entity type:Organization
Organization Name:AMETHYST & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-669-7057
Mailing Address - Street 1:PO BOX 7792
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70010-7792
Mailing Address - Country:US
Mailing Address - Phone:504-832-4989
Mailing Address - Fax:
Practice Address - Street 1:8080 CROWDER BLVD STE E
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1077
Practice Address - Country:US
Practice Address - Phone:504-832-4989
Practice Address - Fax:504-831-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management