Provider Demographics
NPI:1679862239
Name:ROSCHE, SHANNON ELISE (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELISE
Last Name:ROSCHE
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 1:110 E COLEMAN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-4298
Mailing Address - Country:US
Mailing Address - Phone:225-892-0857
Mailing Address - Fax:
Practice Address - Street 1:110 E COLEMAN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4298
Practice Address - Country:US
Practice Address - Phone:225-892-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4389101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health