Individual
SHANTE GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6009 FINANCIAL PLZ STE 230, SHREVEPORT, LA 71129
(318) 670-8858
(318) 670-8947
Mailing address
1513 LINE AVE, SUITE 230, SHREVEPORT, LA 71101-4621
(318) 670-8858
(318) 670-8947
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2160699
—
LA
Enumeration date
03/07/2017
Last updated
05/15/2018
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