MEDICARE: COURTNEY FREDIEU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PLC10907	LA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1083206627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY FREDIEU

Provider Business Mailing Address
First Line	:	3004 KNIGHT ST STE 149
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 KNIGHT ST STE 149
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2502
Country	:	US
Telephone Number	:	318-517-4736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	03/05/2026

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Directions to “ COURTNEY FREDIEU ” Practice Location

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