| Jeanne Street, Phd, Appc | |
|
610 Herndon Ave. Shreveport LA 71101 | |
| (318) 424-3867 | |
| (318) 424-5006 |
| Full Name | Jeanne Street, Phd, Appc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 610 Herndon Ave., Shreveport, Louisiana |
| Authorized Official Name and Position | Jeanne Street (CLINICAL PSYCHOLOGIST/PRESIDENT) |
| Authorized Official Contact | 3184243867 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeanne Street, Phd, Appc 610 Herndon Ave. Shreveport LA 71101 Ph: (318) 424-3867 | Jeanne Street, Phd, Appc 610 Herndon Ave. Shreveport LA 71101 Ph: (318) 424-3867 |
| NPI Number | 1518267889 |
|---|---|
| Provider Enumeration Date | 11/02/2010 |
| Last Update Date | 11/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518267889 | NPI | - | NPPES |
| 1105961 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 342 (Louisiana) | Primary |
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