MEDICARE: MR. JASON PAUL SEAUX

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

General Provider Information

NPI Number	:	1407227325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON PAUL SEAUX

Provider Business Mailing Address
First Line	:	3007 KNIGHT ST
Second Line	:	SUITE 200
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2538
Country	:	US
Telephone Number	:	318-221-8244
Fax Number	:	318-221-1995

Provider Business Practice Location Address
First Line	:	3007 KNIGHT ST
Second Line	:	SUITE 200
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2538
Country	:	US
Telephone Number	:	318-221-8244
Fax Number	:	318-221-1995

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

Provider Enumeration Date	:	10/19/2015
Last Update Date	:	09/07/2016

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