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General NPI Number Information
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NPI Number | 1447512512
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Entity Type | Organization
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Legal Business Name | PEACEFUL ALTERNATIVES COUNSELING AND THERAPY, LLC
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 5902 BUNCOMBE RD
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City | SHREVEPORT
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State | LA
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Zip | 71129-4004
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Country | US
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Telephone | 318-670-8898
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Fax | 318-300-3772
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Provider Business Mailing Address
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Address Line | PO BOX 29372
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City | SHREVEPORT
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State | LA
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Zip | 71149
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Country | US
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Telephone | 318-670-8898
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Fax | 318-300-3772
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS OPERATION/ MHP
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Name | MR. ROBERT TERRY
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Credential | M.A.
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Telephone | 318-670-8898
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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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