Healthcare Provider Details

I. General information

NPI: 1528402922
Provider Name (Legal Business Name): CADDO BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 COLONEL AP KOUNS DR
SHREVEPORT LA
71115-2977
US

IV. Provider business mailing address

195 COLONEL AP KOUNS DR
SHREVEPORT LA
71115-2977
US

V. Phone/Fax

Practice location:
  • Phone: 318-884-4205
  • Fax:
Mailing address:
  • Phone: 318-884-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SANDRA L WILLIAMS
Title or Position: DIRECTOR
Credential: LPC
Phone: 318-884-4205