Provider Demographics
NPI:1891701041
Name:PLEUNE, JOHN RUSSELL (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RUSSELL
Last Name:PLEUNE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2903
Mailing Address - Country:US
Mailing Address - Phone:984-626-7507
Mailing Address - Fax:985-867-3438
Practice Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:SUITE B1
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4930
Practice Address - Country:US
Practice Address - Phone:985-867-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA197103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56438Medicare ID - Type Unspecified