Individual
LAURA L MCCLINTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
710 SLATTERY BLVD, SHREVEPORT, LA 71104-4922
(817) 731-6121
(817) 732-8015
Mailing address
PO BOX 4086, SHREVEPORT, LA 71134-0086
(817) 731-6121
(817) 732-8015
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
020259
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020259
BCBS
LA
05
—
1143227
—
LA
01
—
P00148407
MEDICARE RAILROAD
—
Enumeration date
02/20/2006
Last updated
10/29/2007
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