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General NPI Number Information
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NPI Number | 1558804740
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Entity Type | Organization
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Legal Business Name | RED RIVER THERAPEUTIC SOULUTIONS
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 7000 RED FOX TRL APT 237
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City | SHREVEPORT
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State | LA
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Zip | 71129-3546
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Country | US
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Telephone | 318-423-7963
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 RED FOX TRL APT 237
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City | SHREVEPORT
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State | LA
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Zip | 71129-3546
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Country | US
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Telephone | 318-423-7963
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH PROFESSIONSAL
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Name | MRS. VONETTA FAYE COOK
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Credential | BS
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Telephone | 318-402-7789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 251S00000X
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License Number State | LA
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