Healthcare Provider Details

I. General information

NPI: 1811291099
Provider Name (Legal Business Name): MS. BARBARA MARIE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 PINE HILL RD
SHREVEPORT LA
71107-2604
US

IV. Provider business mailing address

5100 PINE HILL RD
SHREVEPORT LA
71107-2604
US

V. Phone/Fax

Practice location:
  • Phone: 318-617-5100
  • Fax: 318-929-2564
Mailing address:
  • Phone: 318-617-5100
  • Fax: 318-929-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC#653
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberA046503
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: