Provider Demographics
NPI:1215695689
Name:SHAHEEN, GEORGIA LEIGH (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:LEIGH
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 SUGAR CANE LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7886
Mailing Address - Country:US
Mailing Address - Phone:225-202-1296
Mailing Address - Fax:
Practice Address - Street 1:10211 SIEGEN LN STE 2B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-4988
Practice Address - Country:US
Practice Address - Phone:225-767-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical