Individual
DR. SHANNON BURTON PECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4957
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4957
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
32882
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177186701
—
TX
Enumeration date
01/02/2007
Last updated
08/02/2013
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