Healthcare Provider Details

I. General information

NPI: 1215300553
Provider Name (Legal Business Name): WILLIAM M. CALHOUN M.S., M.A., LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CENTENARY BLVD
SHREVEPORT LA
71104
US

IV. Provider business mailing address

2620 CENTENARY BLVD
SHREVEPORT LA
71104-3356
US

V. Phone/Fax

Practice location:
  • Phone: 318-681-9935
  • Fax:
Mailing address:
  • Phone: 318-681-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1405
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1405
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: