1437413192 NPI number — THERESE DIANE SCHAFFNER LAC, LPC-S, NCC

Table of content: THERESE DIANE SCHAFFNER LAC, LPC-S, NCC (NPI 1437413192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437413192 NPI number — THERESE DIANE SCHAFFNER LAC, LPC-S, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAFFNER
Provider First Name:
THERESE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAC, LPC-S, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437413192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 ROSS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAUGHTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71037-8288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-210-1539
Provider Business Mailing Address Fax Number:
318-584-7133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3821 SOUTHERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71106-1033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-946-8157
Provider Business Practice Location Address Fax Number:
318-216-5868
Provider Enumeration Date:
06/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  4907 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 1454 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3353458 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".