Healthcare Provider Details

I. General information

NPI: 1447817614
Provider Name (Legal Business Name): D'SHAWN PAUL ETIENNE LPC, PLMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 06/15/2023
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 N 6TH ST SUITE 2
WEST MONROE LA
71291
US

IV. Provider business mailing address

403 N 6TH ST STE 2
WEST MONROE LA
71291-4119
US

V. Phone/Fax

Practice location:
  • Phone: 318-737-7201
  • Fax: 318-737-7693
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7908
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1387
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: