Individual
JESSE TYLER MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
11990 JACKSON ST, CLINTON, LA 70722
(225) 683-5292
(225) 683-1310
Mailing address
PO BOX 395, CLINTON, LA 70722-0395
(225) 683-5292
(225) 683-1310
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
6784
LA
171M00000X
Case Manager/Care Coordinator
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6784
STATE OF LOUISIANA LICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS
LA
Enumeration date
06/29/2016
Last updated
10/31/2019
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us