Provider Demographics
NPI:1821438359
Name:LEBLANC, JON-MICHAEL (LPC)
Entity Type:Individual
Prefix:
First Name:JON-MICHAEL
Middle Name:
Last Name:LEBLANC
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 1:2120 BERT KOUNS INDUSTRIAL LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3351
Mailing Address - Country:US
Mailing Address - Phone:318-688-3350
Mailing Address - Fax:
Practice Address - Street 1:1560 IRVING PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4604
Practice Address - Country:US
Practice Address - Phone:318-415-6010
Practice Address - Fax:888-815-0822
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7993101YP2500X
TX88106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional