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General NPI Number Information
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NPI Number | 1124764964
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Entity Type | Organization
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Legal Business Name | REACH FOR RECOVERY
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 1701 OLD MINDEN RD STE 17F
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City | BOSSIER CITY
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State | LA
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Zip | 71111-4804
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Country | US
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Telephone | 318-317-1238
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Fax | 318-390-1802
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Provider Business Mailing Address
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Address Line | 1701 OLD MINDEN RD STE 17F
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City | BOSSIER CITY
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State | LA
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Zip | 71111-4804
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Country | US
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Telephone | 318-317-1238
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Fax | 318-390-1802
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Authorized Official
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Title or Position | OWNER
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Name | TIA DESHAUN THOMAS
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Credential | APRN, FNP-C
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Telephone | 318-317-1238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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