Healthcare Provider Details

I. General information

NPI: 1205325396
Provider Name (Legal Business Name): ANGELA KALYN CALHOUN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 KNIGHT ST STE 434
SHREVEPORT LA
71105-2413
US

IV. Provider business mailing address

549 MERRICK ST
SHREVEPORT LA
71104-2307
US

V. Phone/Fax

Practice location:
  • Phone: 318-631-1122
  • Fax:
Mailing address:
  • Phone: 318-667-0617
  • Fax:

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 Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC005200
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: