=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679933386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2016
-----------------------------------------------------
Last Update Date | 02/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1513 LINE AVE SUITE 222
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71101-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-626-5766
-----------------------------------------------------
Fax | 318-716-1194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1513 LINE AVE SUITE 222
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71101-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-626-5766
-----------------------------------------------------
Fax | 318-716-1194
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LARIANA GRAHAM-TAYLOR
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 318-626-5766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------