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General NPI Number Information
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NPI Number | 1871725192
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF HEALTH & HOSPITALS
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 2924 KNIGHT ST BUILDING III, 2ND FLOOR, SUITE 350
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City | SHREVEPORT
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State | LA
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Zip | 71105-2415
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Country | US
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Telephone | 318-862-3053
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Fax | 318-862-3057
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Provider Business Mailing Address
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Address Line | 2924 KNIGHT ST BUILDING III, 2ND FLOOR, SUITE 350
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City | SHREVEPORT
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State | LA
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Zip | 71105-2415
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Country | US
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Telephone | 318-862-3053
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Fax | 318-862-3080
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Authorized Official
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Title or Position | DIR. OF OPERATIONS
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Name | MS. ALLIE D. ALLEN
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Credential |
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Telephone | 318-676-5160
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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 | 105
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License Number State | LA
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