Provider Demographics
NPI:1770084113
Name:MAZZANTI, JENNIFER ANNE (MS, LPC, LAC, CATF)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:MAZZANTI
Suffix:
Gender:
Credentials:MS, LPC, LAC, CATF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PINE GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7736
Mailing Address - Country:US
Mailing Address - Phone:318-380-2486
Mailing Address - Fax:
Practice Address - Street 1:209 PINE GROVE CIR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7736
Practice Address - Country:US
Practice Address - Phone:318-380-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP2500X, 101YM0800X
LA7266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional