Healthcare Provider Details

I. General information

NPI: 1649797481
Provider Name (Legal Business Name): ALLIANCE COUNSELING AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 BEECH ST
TEXARKANA AR
71854
US

IV. Provider business mailing address

2285 BENTON RD STE D103
BOSSIER CITY LA
71111-3465
US

V. Phone/Fax

Practice location:
  • Phone: 318-268-1402
  • Fax:
Mailing address:
  • Phone: 318-584-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: WARREN P STUMON
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-344-4063