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General NPI Number Information
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NPI Number | 1598059719
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Entity Type | Individual
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Provider Name | SATYAPRABHA REDDY BOLLAM LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 820 JORDAN ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-4518
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Country | US
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Telephone | 318-458-7713
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Fax | 318-754-4195
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Provider Business Mailing Address
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Address Line | 820 JORDAN ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-4518
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Country | US
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Telephone | 318-458-7713
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Fax | 318-754-4195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4362
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5863
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 12182
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4613
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1177
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License Number State | LA
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