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NPI Code Detail

MEDICARE: MS. TERRI GREEN-ANDERSON LMSW, LAC

MEDICARE:  MS. TERRI  GREEN-ANDERSON  LMSW, 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
11041C0700XClinical Social Worker4833LA
2101YA0400XAddiction (Substance Use Disorder) Counselor1075LA

General Provider Information

NPI Number : 1417987082
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TERRI GREEN-ANDERSON LMSW, LAC
Provider Business Mailing Address
First Line : 1310 N HEARNE AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-6516
Country : US
Telephone Number : 318-676-5111
Fax Number : 318-676-5126
Provider Business Practice Location Address
First Line : 1310 N HEARNE AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-6516
Country : US
Telephone Number : 318-676-5111
Fax Number : 318-676-5126
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 06/16/2018

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Directions to “ MS. TERRI GREEN-ANDERSON LMSW, LAC” Practice Location

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