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NPI Code Detail

MEDICARE: MR. JEREMY A LUALLEN MSMFT, PLPC

MEDICARE: MR. JEREMY A LUALLEN MSMFT, PLPC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1841515087
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEREMY A LUALLEN MSMFT, PLPC
Provider Business Mailing Address
First Line : 622 RIVERSIDE DR
Second Line :
City : MONROE
State : LA
Zip : 71201-6211
Country : US
Telephone Number : 318-398-1760
Fax Number :
Provider Business Practice Location Address
First Line : 622 RIVERSIDE DR
Second Line :
City : MONROE
State : LA
Zip : 71201-6211
Country : US
Telephone Number : 318-398-1760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2010
Last Update Date : 12/21/2015

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