Healthcare Provider Details

I. General information

NPI: 1831586379
Provider Name (Legal Business Name): ROBERT FLOWERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BELVIEW RD
LEESVILLE LA
71446-2902
US

IV. Provider business mailing address

1220 DOGWOOD CIR
LEESVILLE LA
71446-9429
US

V. Phone/Fax

Practice location:
  • Phone: 337-238-6431
  • Fax:
Mailing address:
  • Phone: 318-265-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2494
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: