Organization
THE CHILDRENS COUNSELING CENTER OF SHREVEPORT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESS M MCENTEE IV LPC (PRESIDENT THERAPIST)
(318) 949-0951
Entity
Organization
Contact information
Practice address
225 MAHAFFEY RD, PRINCETON, LA 71067
(318) 949-0951
(318) 949-0951
Mailing address
225 MAHAFFEY RD, PRINCETON, LA 71067
(318) 949-0951
(318) 949-0951
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
112
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4434895890
BLUE CROSS OF LA
LA
01
—
552827
MAGELLAN
LA
Enumeration date
06/06/2008
Last updated
06/06/2008
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