Healthcare Provider Details

I. General information

NPI: 1104278019
Provider Name (Legal Business Name): SHAUNTEE SLACK LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 LAMY LN STE I
MONROE LA
71201-9200
US

IV. Provider business mailing address

101 MONTICELLO DR
MONROE LA
71203-2918
US

V. Phone/Fax

Practice location:
  • Phone: 318-953-5944
  • Fax:
Mailing address:
  • Phone: 318-243-3729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC6755
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: