Provider Demographics
NPI:1104278019
Name:SLACK, SHAUNTEE (LPC-S)
Entity type:Individual
Prefix:DR
First Name:SHAUNTEE
Middle Name:
Last Name:SLACK
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4071
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-4071
Mailing Address - Country:US
Mailing Address - Phone:318-953-5944
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 4071
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71211-4071
Practice Address - Country:US
Practice Address - Phone:318-953-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC6755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty