Individual
JERMINE THERESA PRATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2104 CLECO STREET, MANSURA, LA 71350
(318) 964-2679
(318) 964-2683
Mailing address
POST OFFICE BOX 450, MANSURA, LA 71350
(318) 964-2679
(318) 964-2683
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1544761
—
LA
01
—
1679507412
NPI
LA
01
—
721422495
TAX IDENTIFICATION
LA
Enumeration date
06/28/2017
Last updated
06/16/2023
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