Healthcare Provider Details

I. General information

NPI: 1689343071
Provider Name (Legal Business Name): LATRINA HOWARD HOGAN MASTERS OF SCIENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/06/2025
Certification Date: 09/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 KNIGHT ST STE 155
SHREVEPORT LA
71105-2412
US

IV. Provider business mailing address

411 MONROE ST
MANSFIELD LA
71052-3211
US

V. Phone/Fax

Practice location:
  • Phone: 318-429-6975
  • Fax:
Mailing address:
  • Phone: 318-871-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC9579
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number99910
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: