MEDICARE: ENVISION COUNSELING SERVICES LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1235539644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	7505 PINES RD STE 1230
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-3900
Country	:	US
Telephone Number	:	318-562-3707
Fax Number	:	318-562-3708

Provider Business Practice Location Address
First Line	:	7505 PINES RD STE 1230
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-3900
Country	:	US
Telephone Number	:	318-562-3707
Fax Number	:	318-562-3708

Authorized Official
Title or Position	:	CEO
Name	:	CHARME SHUNTE THOMPSON
Credential	:	LPC
Telephone Number	:	318-219-6112

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	06/29/2023

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Directions to “ENVISION COUNSELING SERVICES LLC ” Practice Location

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