MEDICARE: DR. CAROL JANNIK PH.D.

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	103TC1900X	Counseling Psychologist	456	LA
2	101YP2500X	Professional Counselor	456	LA

General Provider Information

NPI Number	:	1437422367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL JANNIK PH.D.

Provider Business Mailing Address
First Line	:	516 MARION ST
Second Line	:
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457-5539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6863 TOURNAMENT DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1219
Country	:	US
Telephone Number	:	318-228-7143
Fax Number	:

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

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	11/27/2024

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