Provider Demographics
NPI:1942751201
Name:JENA BAND OF CHOCTAW INDIANS
Entity type:Organization
Organization Name:JENA BAND OF CHOCTAW INDIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR-PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:318-233-2257
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-0014
Mailing Address - Country:US
Mailing Address - Phone:318-922-0136
Mailing Address - Fax:318-220-1724
Practice Address - Street 1:906 LAPALI HINA ST
Practice Address - Street 2:
Practice Address - City:TROUT
Practice Address - State:LA
Practice Address - Zip Code:71371-3508
Practice Address - Country:US
Practice Address - Phone:318-992-2763
Practice Address - Fax:318-992-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty