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General NPI Number Information
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NPI Number | 1376314385
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Entity Type | Organization
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Legal Business Name | FALLIS COUNSELING LLC
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 5657 N LAKESHORE DR
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City | SHREVEPORT
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State | LA
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Zip | 71107-9382
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Country | US
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Telephone | 318-218-2360
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Fax | 318-668-7811
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Provider Business Mailing Address
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Address Line | 5657 N LAKESHORE DR
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City | SHREVEPORT
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State | LA
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Zip | 71107-9382
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Country | US
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Telephone | 318-218-2360
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JESSE FALLIS SR.
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Credential | NCC LPC
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Telephone | 318-218-2360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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