Healthcare Provider Details

I. General information

NPI: 1851893812
Provider Name (Legal Business Name): DEBORAH ALEXANDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4571 N MARKET ST
SHREVEPORT LA
71107-2917
US

IV. Provider business mailing address

6610 SANTA MONICA BLVD
SHREVEPORT LA
71119-7113
US

V. Phone/Fax

Practice location:
  • Phone: 318-424-8735
  • Fax: 318-424-8739
Mailing address:
  • Phone: 318-426-6022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7748
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: