Individual
JONAS MALIK ETIENNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
124 ABIGAYLE ROW, SCOTT, LA 70583-8909
(337) 504-2655
Mailing address
124 ABIGAYLE ROW, SCOTT, LA 70583-8909
(337) 504-2655
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
010641193
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JE035
—
LA
Enumeration date
08/21/2018
Last updated
08/21/2018
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