Healthcare Provider Details

I. General information

NPI: 1861948143
Provider Name (Legal Business Name): MARY JAMES-THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 KNIGHT ST STE 426
SHREVEPORT LA
71105-2414
US

IV. Provider business mailing address

932 FRANCAIS DR
SHREVEPORT LA
71118-4050
US

V. Phone/Fax

Practice location:
  • Phone: 318-754-3560
  • Fax: 318-779-0439
Mailing address:
  • Phone: 318-426-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1790829646
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number14628
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14628
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: