Healthcare Provider Details

I. General information

NPI: 1164038550
Provider Name (Legal Business Name): ELIZABETH WESTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 YOUREE DR
SHREVEPORT LA
71105-2122
US

IV. Provider business mailing address

3616 YOUREE DR
SHREVEPORT LA
71105-2122
US

V. Phone/Fax

Practice location:
  • Phone: 318-779-0104
  • Fax: 318-421-3193
Mailing address:
  • Phone: 318-779-0104
  • Fax: 318-421-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: