{
"Npi": {
"NPI": "1912581687",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTH WEST LOUISIANA BEHAVIORAL SERVICES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7505 PINES RD STE 1100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHREVEPORT",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71129-3900",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "318-683-4086",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1953 DANIEL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ARCADIA",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "71001-3030",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "318-349-7730",
"PracticeLocationAddressFaxNumber": "318-683-4087",
"EnumerationDate": "05/10/2021",
"LastUpdateDate": "05/10/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "TALESHA",
"AuthorizedOfficialMiddleName": "ANTOINETTE",
"AuthorizedOfficialTitle": "ADMIN/MENTAL HEALTH SPECIALIST",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "318-349-7730",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171M00000X",
"TaxonomyName": "Case Manager/Care Coordinator",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}