Provider Demographics
NPI:1588958334
Name:RAZEPINA, ELENA VLADIMIROVNA (MA,LPC)
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:VLADIMIROVNA
Last Name:RAZEPINA
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10037 SMITHERMAN DR
Mailing Address - Street 2:10037 SMITHERMAN DR.,
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2924
Mailing Address - Country:US
Mailing Address - Phone:318-560-5746
Mailing Address - Fax:
Practice Address - Street 1:707 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2219
Practice Address - Country:US
Practice Address - Phone:318-869-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional