=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477816569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARWOOD COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2012
-----------------------------------------------------
Last Update Date | 06/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6171 BERT KOUNS LOOP D105
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71129-5061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-686-0276
-----------------------------------------------------
Fax | 318-678-5956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6171 BERT KOUNS LOOP D105
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71129-5061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-686-0276
-----------------------------------------------------
Fax | 318-678-5956
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JOY HARRIS-WOODARD
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 318-686-0276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 4136
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------