Healthcare Provider Details

I. General information

NPI: 1154951986
Provider Name (Legal Business Name): M. TODD LOBRANO, PSYCHOLOGIST, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 YOUREE DR STE 20A
SHREVEPORT LA
71105-2149
US

IV. Provider business mailing address

3341 YOUREE DR STE 20A
SHREVEPORT LA
71105-2149
US

V. Phone/Fax

Practice location:
  • Phone: 318-425-2000
  • Fax: 318-424-2601
Mailing address:
  • Phone: 318-425-2000
  • Fax: 318-424-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KIMBER FULLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-425-2000