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General NPI Number Information
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NPI Number | 1962274159
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Entity Type | Organization
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Legal Business Name | LATOYA RANDALL COUNSELING AND CONSULTING
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 443 SAINT CHARLES BLVD
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City | SHREVEPORT
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State | LA
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Zip | 71106-8541
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Country | US
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Telephone | 318-469-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 1651 E 70TH ST # 320
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City | SHREVEPORT
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State | LA
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Zip | 71105-5115
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Country | US
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Telephone | 318-469-9790
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LATOYA NECHELE RANDALL
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Credential | LPC
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Telephone | 318-469-9790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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License Number State |
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