Healthcare Provider Details

I. General information

NPI: 1154245892
Provider Name (Legal Business Name): JUNIOR LOVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 COLORADO DR
MONROE LA
71203-7345
US

IV. Provider business mailing address

2905 CAMERON ST STE B
MONROE LA
71201-3791
US

V. Phone/Fax

Practice location:
  • Phone: 318-977-1235
  • Fax:
Mailing address:
  • Phone: 318-977-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNY SMITH JR.
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 318-977-1235