Healthcare Provider Details

I. General information

NPI: 1609242320
Provider Name (Legal Business Name): BARBARA MAIDEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 PINES RD STE 1200I
SHREVEPORT LA
71129-3900
US

IV. Provider business mailing address

1513 LINE AVE STE 230
SHREVEPORT LA
71101-4621
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6502
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: