Individual
SHANNON A BRUNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4770
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4770
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1231
LA
Other
Enumeration date
03/18/2013
Last updated
03/18/2013
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