Healthcare Provider Details

I. General information

NPI: 1912581687
Provider Name (Legal Business Name): NORTH WEST LOUISIANA BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 DANIEL ST
ARCADIA LA
71001-3030
US

IV. Provider business mailing address

7505 PINES RD STE 1100
SHREVEPORT LA
71129-3900
US

V. Phone/Fax

Practice location:
  • Phone: 318-349-7730
  • Fax: 318-683-4087
Mailing address:
  • Phone: 318-683-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MS. TALESHA ANTOINETTE SMITH
Title or Position: ADMIN/MENTAL HEALTH SPECIALIST
Credential:
Phone: 318-349-7730