Healthcare Provider Details

I. General information

NPI: 1063123354
Provider Name (Legal Business Name): SHAVEZ JAVON PINESTRAW LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14234 LINDSAY DR
HAMMOND LA
70403-7628
US

IV. Provider business mailing address

PO BOX 2762
HAMMOND LA
70404-2762
US

V. Phone/Fax

Practice location:
  • Phone: 985-974-4972
  • Fax: 985-243-3388
Mailing address:
  • Phone: 985-974-4972
  • Fax: 985-243-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9950
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: