Provider Demographics
NPI:1487861860
Name:RELIFORD, JANICE HORTON (LPC, LMFT, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:HORTON
Last Name:RELIFORD
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 MERRICK ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2208
Mailing Address - Country:US
Mailing Address - Phone:318-617-4385
Mailing Address - Fax:318-227-9505
Practice Address - Street 1:2800 YOUREE DR STE 426 BLDG B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3665
Practice Address - Country:US
Practice Address - Phone:318-617-4385
Practice Address - Fax:318-227-9505
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2575101YP2500X
LA301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA020144124OtherSTATE PROVIDER NUMBER OCS
LA061764986OtherTAX IDENTIFICATION NUMBER