Provider Demographics
NPI:1447767389
Name:FRANKLIN, JERRY W (LPC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:W
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5179
Mailing Address - Country:US
Mailing Address - Phone:318-294-2122
Mailing Address - Fax:
Practice Address - Street 1:2285 BENTON RD BLDG 3
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7933
Practice Address - Country:US
Practice Address - Phone:318-294-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional