MEDICARE: MS. JACQUELINE YVONNE MANWARING RSW,MA,LPC,LMFT,NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	88025	MD
2	101YP2500X	Professional Counselor	2913	LA
3	104100000X	Social Worker	6633	LA
4	106H00000X	Marriage & Family Therapist	857	LA

General Provider Information

NPI Number	:	1245270768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE YVONNE MANWARING RSW,MA,LPC,LMFT,NCC

Provider Business Mailing Address
First Line	:	2620 CENTENARY BLVD
Second Line	:	SUITE306
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3356
Country	:	US
Telephone Number	:	318-676-3332
Fax Number	:	318-676-3335

Provider Business Practice Location Address
First Line	:	2620 CENTENARY BLVD
Second Line	:	SUITE306
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3356
Country	:	US
Telephone Number	:	318-676-3332
Fax Number	:	318-676-3335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	09/11/2025

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