Organization
JEANNE STREET, PHD, APPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE STREET PH.D. (CLINICAL PSYCHOLOGIST/PRESIDENT)
(318) 424-3867
Entity
Organization
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
Enumeration date
11/02/2010
Last updated
11/02/2010
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