MEDICARE: DR. JEAN HUNTER HOLLENSHEAD PSYCHOLOGIST

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	103TC0700X	Clinical Psychologist	452	LA
2	103T00000X	Psychologist	452	LA
3	103TC2200X	Clinical Child & Adolescent Psychologist	452	LA

General Provider Information

NPI Number	:	1356397665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN HUNTER HOLLENSHEAD PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	7717 CRESWELL RD LOT 34
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-6033
Country	:	US
Telephone Number	:	318-470-6103
Fax Number	:	318-798-4171

Provider Business Practice Location Address
First Line	:	820 JORDAN ST
Second Line	:	SUITE J
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4518
Country	:	US
Telephone Number	:	318-470-6103
Fax Number	:	318-798-4171

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	04/06/2012

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