Healthcare Provider Details

I. General information

NPI: 1982058756
Provider Name (Legal Business Name): AUTUMN CREEK HEALTH SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 KNIGHT ST SUITE 426
SHREVEPORT LA
71105-2415
US

IV. Provider business mailing address

2924 KNIGHT ST SUITE 426
SHREVEPORT LA
71105-2415
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH0011664
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON TERRELL
Title or Position: OWNER/CEO
Credential: MS
Phone: 318-453-3895