Healthcare Provider Details

I. General information

NPI: 1710918669
Provider Name (Legal Business Name): ALTON MCKNIGHT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 LINE AVE
SHREVEPORT LA
71104-3022
US

IV. Provider business mailing address

2520 LINE AVE
SHREVEPORT LA
71104-3022
US

V. Phone/Fax

Practice location:
  • Phone: 318-222-6226
  • Fax: 318-221-8526
Mailing address:
  • Phone: 318-222-6226
  • Fax: 318-221-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number156
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: