Individual
BEVERLY M JEFFERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
118 VILLAGE ST, SLIDELL, LA 70458-5302
(601) 618-4083
Mailing address
8326 KELWOOD AVE, BATON ROUGE, LA 70806-4803
(601) 618-4083
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/05/2017
Last updated
03/19/2020
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