Jennifer L Russell, Psychologist, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

JENNIFER L RUSSELL, PSYCHOLOGIST, LLC

Practice address

2800 Youree Dr Ste 369
Shreveport, LA 71104-3646

Phone

(318) 685-9148

Fax

(318) 693-0103

NPI assigned

Jan 21, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Josie LarkinsNPI 1720757487

Title

Office Manager

Phone

(318) 685-9148

Specialties & licenses 1

Addresses

Other names 1

• Clinical & Forensic Psychology of Shreveport Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Russell, PH.D.

  • Clinical Psychologist
  • Shreveport, LA
  • NPI 1114347846
  Medicare reassignment NPD
• Josie Larkins

  • Behavior Technician
  • Bossier City, LA
  • NPI 1720757487
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1316577141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 YOUREE DR STE 369",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711043646",
            "telephone_number": "318-685-9148",
            "fax_number": "318-693-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 YOUREE DR STE 369",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711043646",
            "telephone_number": "318-685-9148",
            "fax_number": "318-693-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER L RUSSELL, PSYCHOLOGIST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "LARKINS",
        "authorized_official_first_name": "JOSIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-685-9148"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinical & Forensic Psychology of Shreveport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rashima R Jenkins
• Robert Clifton Jenkins, CRNA
• Sharon Demetris Jenkins
• Tryphena M Jenkins, LCSW
• Kyle Jenks
• Brittany Jennings
• Staughton Jennings
• Stephanie Jennings, OTR
• Tiffany Ann Jennings, PSYD
• Majed Aldin Jeroudi, M.D.

• Clinical Psychologist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Clinical Psychologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.