1487861860 NPI number — MRS. JANICE HORTON RELIFORD LPC, LMFT, NCC

Table of content: MRS. JANICE HORTON RELIFORD LPC, LMFT, NCC (NPI 1487861860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487861860 NPI number — MRS. JANICE HORTON RELIFORD LPC, LMFT, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RELIFORD
Provider First Name:
JANICE
Provider Middle Name:
HORTON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LMFT, 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:
1487861860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
734 MERRICK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71104-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-617-4385
Provider Business Mailing Address Fax Number:
318-227-9505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 YOUREE DR STE 426 BLDG B
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:
71104-3665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-617-4385
Provider Business Practice Location Address Fax Number:
318-227-9505
Provider Enumeration Date:
05/17/2007

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:  2575 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 301 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 020144124 . This is a "STATE PROVIDER NUMBER OCS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 061764986 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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