Healthcare Provider Details

I. General information

NPI: 1174262745
Provider Name (Legal Business Name): SAVANNAH JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 KNIGHT ST STE 149
SHREVEPORT LA
71105-2502
US

IV. Provider business mailing address

622 RIVERSIDE DR
MONROE LA
71201-6211
US

V. Phone/Fax

Practice location:
  • Phone: 318-227-8390
  • Fax: 318-429-2414
Mailing address:
  • Phone: 318-227-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9330
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: