Individual
MARK NETTLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
748 CECILE PL, SHREVEPORT, LA 71106-1202
(318) 525-6979
Mailing address
748 CECILE PL, SHREVEPORT, LA 71106-1202
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5331
LA
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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