Individual
MR. JOHN TRUMAN FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
4440 CANAL STREET, NEW ORLEANS, LA 70119-6021
(504) 421-0730
(888) 959-6762
Mailing address
715 PECAN GROVE LN, JEFFERSON, LA 70121-1130
(504) 421-0730
(888) 959-6762
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
468
LA
103TC0700X
Clinical Psychologist
Primary
468
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1552836
—
LA
Enumeration date
05/16/2007
Last updated
10/03/2016
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