Provider Demographics
NPI:1770631814
Name:RIEVESCHL, JAN LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:LOUIS
Last Name:RIEVESCHL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1419 AMELIA ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3624
Mailing Address - Country:US
Mailing Address - Phone:504-895-6524
Mailing Address - Fax:504-896-4977
Practice Address - Street 1:1419 AMELIA ST
Practice Address - Street 2:SUITE #1
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3624
Practice Address - Country:US
Practice Address - Phone:504-895-6524
Practice Address - Fax:504-896-4977
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA389103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical