Provider Demographics
NPI:1699515858
Name:COLBENSON, JESSICA LYNNE (PLPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:COLBENSON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 LEBLANC LN
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-5765
Mailing Address - Country:US
Mailing Address - Phone:504-813-5564
Mailing Address - Fax:
Practice Address - Street 1:17534 OLD JEFFERSON HWY STE B2
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3978
Practice Address - Country:US
Practice Address - Phone:225-244-9110
Practice Address - Fax:504-335-0775
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10158101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor