Provider Demographics
NPI:1679929210
Name:NETTLES, JENNIFER (LPC, NCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NETTLES
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 N TURNBULL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5732
Mailing Address - Country:US
Mailing Address - Phone:504-302-7771
Mailing Address - Fax:
Practice Address - Street 1:3216 N TURNBULL DR
Practice Address - Street 2:SUITE A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5732
Practice Address - Country:US
Practice Address - Phone:504-302-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional