Provider Demographics
NPI:1881241180
Name:BACILE, JENNIFER ANN (MS, PLPC, NCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:BACILE
Suffix:
Gender:F
Credentials:MS, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 RED MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6284
Mailing Address - Country:US
Mailing Address - Phone:850-228-3800
Mailing Address - Fax:
Practice Address - Street 1:604 E 15TH STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-960-7293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC7989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health