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NPI Code Detail

MEDICARE: HUMANITY2020 GROUP

MEDICARE: HUMANITY2020 GROUP
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1164116430
Entity Type Code : Organization
Provider Name (Legal Business Name) : HUMANITY2020 GROUP
Provider Business Mailing Address
First Line : 2720 FAIRFIELD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2924
Country : US
Telephone Number : 318-895-6106
Fax Number :
Provider Business Practice Location Address
First Line : 201 CENTURY VILLAGE BLVD STE 256
Second Line :
City : MONROE
State : LA
Zip : 71203-2008
Country : US
Telephone Number : 318-415-5900
Fax Number :
Authorized Official
Title or Position : CEO/FOUNDER
Name : MAYQUIE JACKSON
Credential :
Telephone Number : 318-895-6106
Provider Enumeration Date : 06/08/2023
Last Update Date : 06/08/2023

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Directions to “HUMANITY2020 GROUP ” Practice Location

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