Healthcare Provider Details

I. General information

NPI: 1326738220
Provider Name (Legal Business Name): SW SENTELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8504 LINE AVE
SHREVEPORT LA
71106-6146
US

IV. Provider business mailing address

8504 LINE AVE
SHREVEPORT LA
71106-6146
US

V. Phone/Fax

Practice location:
  • Phone: 318-868-2001
  • Fax: 318-675-1517
Mailing address:
  • Phone: 318-868-2001
  • Fax: 318-675-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LAURA SENTELL
Title or Position: ADMINISTRATIVE
Credential:
Phone: 318-868-2001