Healthcare Provider Details

I. General information

NPI: 1992950828
Provider Name (Legal Business Name): METROPOLITAN CIRCLES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MELROSE AVE
NATCHITOCHES LA
71457-5926
US

IV. Provider business mailing address

3510 LINWOOD AVE
SHREVEPORT LA
71103-4512
US

V. Phone/Fax

Practice location:
  • Phone: 318-238-3197
  • Fax: 318-238-3199
Mailing address:
  • Phone: 318-636-4194
  • Fax: 318-636-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateLA

VIII. Authorized Official

Name: MS. TAWANA R CALHOUN-BEAUDION
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 318-636-4194