Doctor Name: | MR. IRA JEWITT |
NPI Number: | 1154784767 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | B.A. |
License Number: | |
Business Practice Address: | 120 N Carolina St New Roads, LA - 707603604 |
Business Phone Number: | 2256388449 |
Business Fax Number: | 2256388466 |
Mailing Address: | 120 N Carolina St, NEW ROADS |
State: | LA |
Postal Code: | 707603604 |
Phone Number: | 2256388449 |
Fax Number: | 2256388466 |
NPI Enumeration Date: | 03/31/2016 |
NPI Last Update Date: | 03/31/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |