Individual
JALISSA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4019 PARLIAMENT DR, ALEXANDRIA, LA 71303
(318) 308-9748
Mailing address
4500 QUEEN ELIZABETH CT APT 172, ALEXANDRIA, LA 71303-2757
(337) 718-1539
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-31291
—
Other
Enumeration date
06/27/2018
Last updated
09/07/2018
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