Healthcare Provider Details

I. General information

NPI: 1003279654
Provider Name (Legal Business Name): RED RIVER THERAPEUTIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 MACKEY PL STE 135
SHREVEPORT LA
71118-2528
US

IV. Provider business mailing address

2715 MACKEY PL STE 135
SHREVEPORT LA
71118-2528
US

V. Phone/Fax

Practice location:
  • Phone: 318-220-8423
  • Fax: 318-220-8573
Mailing address:
  • Phone: 318-220-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRANCE LEE
Title or Position: OWNER
Credential:
Phone: 318-423-7963