Individual
JOEY LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9403 MANSFIELD RD, SHREVEPORT, LA 71118-3815
(318) 861-8938
(318) 862-3554
Mailing address
6211 NOTTAWAY DR, SHREVEPORT, LA 71119-6216
(318) 510-8991
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760852511
PELICAN BAYOU COUNSELING AGENCY
LA
Enumeration date
09/17/2019
Last updated
09/17/2019
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