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General NPI Number Information
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NPI Number | 1073869954
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGY SERVICES OF LOUISIANA, LLC
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1754 TEXAS ST
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City | NATCHITOCHES
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State | LA
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Zip | 71457-3429
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Country | US
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Telephone | 866-944-8604
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Fax | 888-330-9069
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Provider Business Mailing Address
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Address Line | 224 WHITE OAK LN
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City | NATCHITOCHES
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State | LA
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Zip | 71457-6708
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Country | US
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Telephone | 866-944-8604
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Fax | 888-330-9069
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Authorized Official
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Title or Position | OWNER/NEUROPSYCHOLOGIST
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Name | DR. TIFFANY JENNINGS
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Credential | PSYD
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Telephone | 866-944-8604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1148
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License Number State | LA
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