Individual
MR. TRACY LAMONT JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2924 KNIGHT ST, SHREVEPORT, LA 71105-2415
(318) 754-3560
Mailing address
114 HAMMERLY DR, SHREVEPORT, LA 71115-3411
(318) 584-9666
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
LA
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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