Healthcare Provider Details

I. General information

NPI: 1396212742
Provider Name (Legal Business Name): SHANNON VALLAIR-FRANKLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W PORT ST
DERIDDER LA
70634-4040
US

IV. Provider business mailing address

4105 KIRKMAN ST
LAKE CHARLES LA
70607-4603
US

V. Phone/Fax

Practice location:
  • Phone: 337-462-1641
  • Fax:
Mailing address:
  • Phone: 337-475-3100
  • Fax: 337-475-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3425
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3425
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: