MEDICARE: MARY STRONG LPC-S, RPT, CAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	86068	TX
2	101YM0800X	Mental Health Counselor	7144	LA
3	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124493218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY STRONG LPC-S, RPT, CAS

Provider Business Mailing Address
First Line	:	731 ACKLEN ST STE 230
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3901
Country	:	US
Telephone Number	:	318-670-8858
Fax Number	:	318-670-8947

Provider Business Practice Location Address
First Line	:	3018 OLD MINDEN RD STE 1206
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2543
Country	:	US
Telephone Number	:	318-350-7676
Fax Number	:	318-350-6767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	01/20/2024

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