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NPI Code Detail

MEDICARE: MYRA CARTER LAC

MEDICARE: MYRA CARTER LAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor796LA

General Provider Information

NPI Number : 1407883879
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRA CARTER LAC
Provider Business Mailing Address
First Line : 6240 GREENWOOD RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71119-8413
Country : US
Telephone Number : 318-632-2010
Fax Number : 318-632-2055
Provider Business Practice Location Address
First Line : 6240 GREENWOOD RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71119-8413
Country : US
Telephone Number : 318-632-2010
Fax Number : 318-632-2055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 07/08/2007

Similar Medicare Providers

1750348462 — DEPARTMENT OF HEALTH AND HOSPITALS
Practice Location Address:
6240 GREENWOOD RD
SHREVEPORT, LA
71119-8413
Practice Phone: 318-632-2010
Practice Fax: 318-632-2055
1386601425 — DEPARTMENT OF HEALTH AND HOSPITALS
Practice Location Address:
6240 GREENWOOD RD
SHREVEPORT, LA
71119-8413
Practice Phone: 318-632-2010
Practice Fax: 318-632-2055
1689600025 — GREGORY R PALLAY LPC , LMFT
Practice Location Address:
6240 GREENWOOD RD
SHREVEPORT, LA
71119-8413
Practice Phone: 318-632-2010
Practice Fax: 318-632-2055
1750310132 — PAUL M SEALE MSW, LCSW
Practice Location Address:
6240 GREENWOOD RD
SHREVEPORT, LA
71119-8413
Practice Phone: 318-632-2010
Practice Fax: 318-632-2055
1689603912 — GARY BAKER LCSW
Practice Location Address:
6240 GREENWOOD RD
SHREVEPORT, LA
71119-8413
Practice Phone: 318-632-2010
Practice Fax: 318-632-2055
1891725487 — CATHY WALKER LCSW
Practice Location Address:
6240 GREENWOOD RD
SHREVEPORT, LA
71119-8413
Practice Phone: 318-632-2010
Practice Fax: 318-632-2055

Directions to “ MYRA CARTER LAC” Practice Location

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