Provider Demographics
NPI:1407308364
Name:GOENS, JODIE ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:ELAINE
Last Name:GOENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 OLD MINDEN RD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2303
Mailing Address - Country:US
Mailing Address - Phone:318-230-3905
Mailing Address - Fax:
Practice Address - Street 1:2223 OLD MINDEN RD
Practice Address - Street 2:SUITE A2
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2303
Practice Address - Country:US
Practice Address - Phone:318-230-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3506101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional