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General NPI Number Information
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NPI Number | 1275709032
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Entity Type | Organization
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Legal Business Name | SUMMER GROVE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 9300 MANSFIELD RD STE 107
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City | SHREVEPORT
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State | LA
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Zip | 71118-3137
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Country | US
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Telephone | 318-469-0146
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Fax | 318-687-0261
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Provider Business Mailing Address
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Address Line | 9300 MANSFIELD RD STE 107
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City | SHREVEPORT
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State | LA
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Zip | 71118-3137
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Country | US
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Telephone | 318-469-0146
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Fax | 318-687-0261
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Authorized Official
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Title or Position | MANAGER AND SOLE MEMBER
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Name | MISS JANET L HUFF
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Credential | LPC
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Telephone | 318-469-0146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC 2593
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License Number State | LA
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