Provider Demographics
NPI:1356397665
Name:HOLLENSHEAD, JEAN HUNTER (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:HUNTER
Last Name:HOLLENSHEAD
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 CRESWELL RD LOT 34
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6033
Mailing Address - Country:US
Mailing Address - Phone:318-470-6103
Mailing Address - Fax:318-798-4171
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:SUITE J
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4518
Practice Address - Country:US
Practice Address - Phone:318-470-6103
Practice Address - Fax:318-798-4171
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA452103TC0700X, 103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent