MEDICARE: MARTHA JANE LOKER DOUCIERE PH.D.

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	101Y00000X	Counselor	1701	LA
2	106H00000X	Marriage & Family Therapist	485	LA

General Provider Information

NPI Number	:	1952664955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA JANE LOKER DOUCIERE PH.D.

Provider Business Mailing Address
First Line	:	3100 RIDGELAKE DRIVE
Second Line	:	STE. 207
City	:	METAIRIE
State	:	LA
Zip	:	70002-4938
Country	:	US
Telephone Number	:	504-836-6961
Fax Number	:	504-836-6951

Provider Business Practice Location Address
First Line	:	3100 RIDGELAKE DRIVE
Second Line	:	STE. 207
City	:	METAIRIE
State	:	LA
Zip	:	70002-4938
Country	:	US
Telephone Number	:	504-836-6961
Fax Number	:	504-836-6951

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

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	06/25/2012

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