NPIMap

Organization Active NPI

Jeanne Street, PHD, Appc

  • Clinical Psychologist
  • Shreveport, LA
National Provider Identifier
1518267889
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
342 Issued in LA
Legal business name
JEANNE STREET, PHD, APPC
Practice address
610 Herndon Ave.
Shreveport, LA 71101
Phone
(318) 424-3867
Fax
(318) 424-5006
NPI assigned
Nov 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

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

Authorized official

Name
Jeanne Street, PH.D.
Title
Clinical Psychologist/President
Phone
(318) 424-3867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 342 LA Primary

Addresses

Primary practice location

610 Herndon Ave.
Shreveport, LA 71101

Mailing address

610 Herndon Ave.
Shreveport, LA 71101
Phone (318) 424-3867

Other identifiers 1

IdentifierTypeStateIssuer
1105961MedicaidLA

National Provider Directory

National Provider Directory

Locations

610 Herndon St
Shreveport, LA 71101
Phone (318) 424-3867

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288656000000",
    "number": "1518267889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 HERNDON AVE.",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71101",
            "telephone_number": "318-424-3867",
            "fax_number": "318-424-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 HERNDON AVE.",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71101",
            "telephone_number": "318-424-3867",
            "fax_number": "318-424-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEANNE STREET, PHD, APPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-02",
        "last_updated": "2010-11-02",
        "status": "A",
        "authorized_official_last_name": "STREET",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST/PRESIDENT",
        "authorized_official_telephone_number": "318-424-3867",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "LA",
            "license": "342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1105961",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; 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.