MEDICARE: MRS. CASSANDRA ANNE KEMMERER LPC,LMFT

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	101YP2500X	Professional Counselor	2582	LA

General Provider Information

NPI Number	:	1528258092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSANDRA ANNE KEMMERER LPC,LMFT

Provider Business Mailing Address
First Line	:	102 E PROSPECT ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2522
Country	:	US
Telephone Number	:	318-673-1010
Fax Number	:	318-673-1424

Provider Business Practice Location Address
First Line	:	2620 CENTENARY BLVD
Second Line	:	BLDG. 1 STE. 118
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3356
Country	:	US
Telephone Number	:	318-673-1010
Fax Number	:	318-673-1424

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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