| Goebel & Vigen | |
|
3341 Youree Dr Ste 20a Shreveport LA 71105-2149 | |
| (318) 425-2000 | |
| (318) 424-2601 |
| Full Name | Goebel & Vigen |
|---|---|
| Speciality | Psychologist |
| Location | 3341 Youree Dr Ste 20a, Shreveport, Louisiana |
| Authorized Official Name and Position | Ronald A. Goebel (PARTNER) |
| Authorized Official Contact | 3184252000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Goebel & Vigen 3341 Youree Dr Ste 20a Shreveport LA 71105-2149 Ph: (318) 425-2000 | Goebel & Vigen 3341 Youree Dr Ste 20a Shreveport LA 71105-2149 Ph: (318) 425-2000 |
| NPI Number | 1477732188 |
|---|---|
| Provider Enumeration Date | 10/30/2007 |
| Last Update Date | 01/08/2020 |
| Certification Date | 01/08/2020 |
| Medicare PECOS PAC ID | 2163582925 |
|---|---|
| Medicare Enrollment ID | O20081124000449 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477732188 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mark P Vigen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457329120 PECOS PAC ID: 2062572829 Enrollment ID: I20081124000484 |
| Provider Name | Michael Todd Lobrano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750761847 PECOS PAC ID: 8022327626 Enrollment ID: I20151022000242 |
| Provider Name | Jennifer L Russell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114347846 PECOS PAC ID: 1951626035 Enrollment ID: I20170728000500 |
| Provider Name | Shelley Visconte |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235303710 PECOS PAC ID: 0143504746 Enrollment ID: I20171011001120 |
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