Provider Demographics
NPI:1417130378
Name:BIRMINGHAM, JANELL KAY (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANELL
Middle Name:KAY
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JORDAN ST
Mailing Address - Street 2:SUITE 510E
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4518
Mailing Address - Country:US
Mailing Address - Phone:318-227-0475
Mailing Address - Fax:318-227-1119
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:SUITE 510E
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4518
Practice Address - Country:US
Practice Address - Phone:318-227-0475
Practice Address - Fax:318-222-1988
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2650101YP2500X
LAMFT759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist