Individual
JEANNIE KANODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
856 TEXAS AVE, SHREVEPORT, LA 71101-3400
(318) 429-6979
(318) 227-6179
Mailing address
856 TEXAS AVE, SHREVEPORT, LA 71101-3400
(318) 429-6979
(318) 227-6179
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4784
LA
101YP2500X
Professional Counselor
4784
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417252230
—
LA
Enumeration date
03/28/2014
Last updated
09/26/2018
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