Provider Demographics
NPI:1770611212
Name:SHER, JEANNIE G (MA, LPC, LRC, CRC)
Entity type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:G
Last Name:SHER
Suffix:
Gender:F
Credentials:MA, LPC, LRC, CRC
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:J
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 HUDSON LN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6066
Mailing Address - Country:US
Mailing Address - Phone:318-322-6500
Mailing Address - Fax:318-322-5118
Practice Address - Street 1:1300 HUDSON LN
Practice Address - Street 2:SUITE 10
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6066
Practice Address - Country:US
Practice Address - Phone:318-322-6500
Practice Address - Fax:318-322-5118
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$0OtherBLUE CROSS PROVIDER ID