Individual
JEANNE STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
610 HERNDON AVE, SHREVEPORT, LA 71101
(318) 424-3867
(318) 424-5006
Mailing address
610 HERNDON AVE, SHREVEPORT, LA 71101
(318) 424-3867
(318) 424-5006
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
342
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1105961
—
LA
01
—
20777
BCBS
LA
Enumeration date
12/21/2006
Last updated
07/08/2007
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