Dwayne Jeter Sr.

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

7505 Pines Rd Ste 1200I
Shreveport, LA 71129-3900

Phone

(318) 716-1707

NPI assigned

Sep 1, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Life Matters Counseling and Therapy, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Shreveport, LA
  • NPI 1407233414
  NPD (past)

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1487100194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104",
            "city": "ELYSIAN FIELDS",
            "state": "TX",
            "postal_code": "756420104",
            "telephone_number": "903-503-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7505 PINES RD STE 1200I",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711293900",
            "telephone_number": "318-716-1707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETER",
        "first_name": "DWAYNE",
        "name_suffix": "Sr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-01",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Jennings, OTR
• Tiffany Ann Jennings, PSYD
• Majed Aldin Jeroudi, M.D.
• Jerry W. Drummond, M.D., a.P.M.C.
• Jeter Speech Language Pathology Services, LLC
• Jeffrey Bennett Jeter, D.D.S.
• Jennifer Rogers Jeter
• Markisha Jeter
• Tonnique Jeter
• Jessica Jett

• Case Manager/Care Coordinator in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Case Manager/Care Coordinator in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.