Healthcare Provider Details

I. General information

NPI: 1285906255
Provider Name (Legal Business Name): SUE C CLOINGER LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CENTENARY BLVD BLDG 3, SUITE 312
SHREVEPORT LA
71104-3356
US

IV. Provider business mailing address

490 ISLAND RD
ELM GROVE LA
71051-8031
US

V. Phone/Fax

Practice location:
  • Phone: 318-681-9935
  • Fax: 318-681-9938
Mailing address:
  • Phone: 318-681-9935
  • Fax: 318-681-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2044
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number846
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: