Healthcare Provider Details

I. General information

NPI: 1356715932
Provider Name (Legal Business Name): NATASHIA DENNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5963 CANADA CT
SHREVEPORT LA
71107
US

IV. Provider business mailing address

6009 FINANCIAL PLZ # 105
SHREVEPORT LA
71129-2615
US

V. Phone/Fax

Practice location:
  • Phone: 318-655-7084
  • Fax:
Mailing address:
  • Phone: 318-670-8858
  • Fax: 318-670-8947

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 NumberCI6298
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: