| Doctor Name: | MS. AMANDA MARIE MOUSHON |
| NPI Number: | 1376815340 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 4017 |
| Business Practice Address: | 2620 Centenary Blvd Building 3, Suite 312 Shreveport, LA - 711043356 |
| Business Phone Number: | 3186819935 |
| Business Fax Number: | 3186819938 |
| Mailing Address: | 3650 Greenway Pl, SHREVEPORT |
| State: | LA |
| Postal Code: | 711052012 |
| Phone Number: | 3184690053 |
| Fax Number: | 3186819938 |
| NPI Enumeration Date: | 02/06/2012 |
| NPI Last Update Date: | 02/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 4017 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |