Provider Demographics
NPI:1740339571
Name:BOOKER, SHELLEY WHITEHEAD (MSW, LCSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:WHITEHEAD
Last Name:BOOKER
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 LONG LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8423
Mailing Address - Country:US
Mailing Address - Phone:318-798-0668
Mailing Address - Fax:318-795-9840
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:SUITE 511
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4518
Practice Address - Country:US
Practice Address - Phone:318-220-7500
Practice Address - Fax:318-220-7000
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical