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NPI Code Detail

MEDICARE: SHALENA WILLIS

MEDICARE: SHALENA WILLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1013389709
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHALENA WILLIS
Provider Business Mailing Address
First Line : 1301 YOUREE DR
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-5117
Country : US
Telephone Number : 318-675-0804
Fax Number : 318-425-9030
Provider Business Practice Location Address
First Line : 1301 YOUREE DR
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-5117
Country : US
Telephone Number : 318-675-0804
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2015
Last Update Date : 05/13/2019

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Directions to “ SHALENA WILLIS ” Practice Location

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