Individual
KEYANA DESHAWN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, NBCC
Contact information
Practice address
4041 DAYTONA AVE, BATON ROUGE, LA 70814
(225) 933-5091
Mailing address
4041 DAYTONA AVE, BATON ROUGE, LA 70814-7145
(225) 933-5091
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5941
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83-2271140
PRIVATE INSURERS
LA
Enumeration date
10/14/2015
Last updated
12/30/2019
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