Basic Information
Provider Information | |||||||||
NPI: | 1922272327 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GIANFORTE | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPC, LMFT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 8580 | ||||||||
Address2: |   | ||||||||
City: | SHREVEPORT | ||||||||
State: | LA | ||||||||
PostalCode: | 711488580 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3186311122 | ||||||||
FaxNumber: | 3188669622 | ||||||||
Practice Location | |||||||||
Address1: | 2924 KNIGHT ST BLDG 4 | ||||||||
Address2: | SUITE 434 | ||||||||
City: | SHREVEPORT | ||||||||
State: | LA | ||||||||
PostalCode: | 711052413 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3186311122 | ||||||||
FaxNumber: | 3188669622 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/16/2008 | ||||||||
LastUpdateDate: | 04/16/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 239 | LA | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 80 | LA | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.