Healthcare Provider Details

I. General information

NPI: 1669670246
Provider Name (Legal Business Name): PENNY LOUISE MILLHOLLON PH.D., LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 JORDAN ST STE 565
SHREVEPORT LA
71101-4526
US

IV. Provider business mailing address

272 HANGING MOSS TRL
SHREVEPORT LA
71106-7621
US

V. Phone/Fax

Practice location:
  • Phone: 318-734-9244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3071
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number987
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: