Individual
KRYSTAL PEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2219 CLAIBORNE AVE, SHREVEPORT, LA 71103-4301
(318) 779-0434
(318) 210-0000
Mailing address
4023 ESPLANADE AVE, SHREVEPORT, LA 71109-5036
(318) 572-7418
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
5809
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/03/2015
Last updated
05/13/2019
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