Provider Demographics
NPI:1508055187
Name:LABORDE, WENDI LEIGH JOHNSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDI
Middle Name:LEIGH JOHNSON
Last Name:LABORDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79885 CIEGO DR
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-1454
Mailing Address - Country:US
Mailing Address - Phone:318-470-8783
Mailing Address - Fax:
Practice Address - Street 1:2620 CENTENARY BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3349
Practice Address - Country:US
Practice Address - Phone:318-227-9225
Practice Address - Fax:318-227-9997
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1006103TC0700X
CAPSY27494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical