Healthcare Provider Details

I. General information

NPI: 1801906185
Provider Name (Legal Business Name): LARRY EDWARD STIER MDIV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

201 CHERRY BLOSSOM LN
BENTON LA
71006-4258
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-8411
  • Fax: 318-424-6121
Mailing address:
  • Phone: 318-742-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: