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General NPI Number Information
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NPI Number | 1982058756
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Entity Type | Organization
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Legal Business Name | AUTUMN CREEK HEALTH SOLUTIONS INC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 2924 KNIGHT ST SUITE 426
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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 | 318-754-3560
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Fax | 318-779-0439
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Provider Business Mailing Address
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Address Line | 2924 KNIGHT ST SUITE 426
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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 | 318-754-3560
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Fax | 318-779-0439
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. SHARON TERRELL
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Credential | MS
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Telephone | 318-453-3895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH0011664
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License Number State | LA
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Taxonomy #4
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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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