Healthcare Provider Details

I. General information

NPI: 1417460262
Provider Name (Legal Business Name): NORTH WEST LOUISIANA BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 PINES RD STE 11115
SHREVEPORT LA
71129-3935
US

IV. Provider business mailing address

7505 PINES RD STE 11115
SHREVEPORT LA
71129-3935
US

V. Phone/Fax

Practice location:
  • Phone: 318-683-4086
  • Fax:
Mailing address:
  • Phone: 318-683-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA J CASEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-683-4086