Provider Demographics
NPI:1235303710
Name:VISCONTE, SHELLEY R (PHD, LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:R
Last Name:VISCONTE
Suffix:
Gender:F
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 YOUREE DR STE 20A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2149
Mailing Address - Country:US
Mailing Address - Phone:318-425-2000
Mailing Address - Fax:318-424-2601
Practice Address - Street 1:3341 YOUREE DR STE 20A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2149
Practice Address - Country:US
Practice Address - Phone:318-425-2000
Practice Address - Fax:318-424-2601
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3008101YP2500X
LA885106H00000X
LA1434103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist