Psychology Associates of N.W. Louisiana, L.L.C.

Primary specialty

Forensic PsychologistTaxonomy code 103TF0200X

Legal business name

PSYCHOLOGY ASSOCIATES OF N.W. LOUISIANA, L.L.C.

Practice address

3341 Youree Dr Ste 20a
Shreveport, LA 71105-2149

Phone

(318) 425-2000

Fax

(318) 424-2601

NPI assigned

Jan 8, 2020

Organization subpart

No

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

Authorized official

Name

Kimber Fuller

Title

Office Manager

Phone

(318) 425-2000

Specialties & licenses 4

Addresses

Other names 1

• Goebel, Vigen, & Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 7

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

• Lillian Holley, LPC

  • Professional Counselor
  • Shreveport, LA
  • NPI 1871718767
  Medicare reassignment Care Compare group NPD
• Robert Lawless, LPC

  • Mental Health Counselor
  • Bossier City, LA
  • NPI 1356724520
  Medicare reassignment Care Compare group NPD
• Michael Todd Lobrano, PH.D.

  • Prescribing (Medical) Psychologist
  • Shreveport, LA
  • NPI 1750761847
  Medicare reassignment Care Compare group NPD
• Zoe Pearl, MS, LPC

  • Mental Health Counselor
  • Shreveport, LA
  • NPI 1447090568
  Medicare reassignment Care Compare group NPD
• Tabitha R Rawls, LPC

  • Counselor
  • Shreveport, LA
  • NPI 1912588229
  Medicare reassignment Care Compare group NPD
• Katie Winningham, LPC

  • Professional Counselor
  • Shreveport, LA
  • NPI 1467207621
  Medicare reassignment Care Compare group NPD
• Jennifer Russell, PH.D.

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

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

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578441600000",
    "number": "1831739820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3341 YOUREE DR STE 20A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052149",
            "telephone_number": "318-425-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3341 YOUREE DR STE 20A",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052149",
            "telephone_number": "318-425-2000",
            "fax_number": "318-424-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGY ASSOCIATES OF N.W. LOUISIANA, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-08",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "KIMBER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-425-2000"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goebel, Vigen, & Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leslie Lewynell Provost
• Elizabeth Pruitt, M.ED
• Evelyn Baranco Pryor, MD
• Jeremy Edwin Pryor
• Psychiatric Nurse Practitioners
• Kenisha Puckett-Threats
• Andrew James Puckett, MD
• Anna Puckett, COTA
• Jessie Puckett
• Shiru Pudasaini

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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.