Provider Demographics
NPI:1982064101
Name:AUSTON-POPO, JESSICA S (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:S
Last Name:AUSTON-POPO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:S
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:714 NORTH WASHINGTON STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220
Mailing Address - Country:US
Mailing Address - Phone:318-814-8801
Mailing Address - Fax:318-300-1169
Practice Address - Street 1:714 NORTH WASHINGTON STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220
Practice Address - Country:US
Practice Address - Phone:318-814-8801
Practice Address - Fax:318-300-1169
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104100000X
LA6236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker