Individual
JESSE FALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
5655 N LAKESHORE DR, SHREVEPORT, LA 71107-9382
(318) 218-2360
(650) 870-2727
Mailing address
5655 N LAKESHORE DR, SHREVEPORT, LA 71107-9382
(318) 218-2360
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
7191
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7191
LICENSED PROFESSIONAL COUNSELOR
LA
01
—
886921
NATIONAL BOARD CERTIFIED COUNSELORS
—
Enumeration date
08/25/2016
Last updated
05/13/2023
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