MEDICARE: BROOKYS HAVEN

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	101Y00000X	Counselor	101Y00000X	LA
2	101YM0800X	Mental Health Counselor	101YM0800X	LA
3	251E00000X	Home Health Agency	101YM0800X	LA
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	103TH0004X	LA
5	101YM0800X	Mental Health Counselor	101Y00000X	LA

General Provider Information

NPI Number	:	1790283638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKYS HAVEN

Provider Business Mailing Address
First Line	:	217 JONES ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4021
Country	:	US
Telephone Number	:	318-423-1367
Fax Number	:	318-216-3380

Provider Business Practice Location Address
First Line	:	217 JONES ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4021
Country	:	US
Telephone Number	:	318-423-1367
Fax Number	:	318-216-3380

Authorized Official
Title or Position	:	OWNER
Name	:	DIANE WILLIAMS
Credential	:
Telephone Number	:	318-423-1367

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	06/16/2018

Similar Medicare Providers

1568606291 — DR. HARRY ALCUS MUSLOW MD
Practice Location Address:

4747 DIXIE GARDEN DR
SHREVEPORT, LA
71105-4021

Practice Phone: 318-861-2604
Practice Fax:

1386096568 — HOPE IN STRUGGLE COUNSELING SERVICES, LLC
Practice Location Address:

4021 GREENWOOD RD
SHREVEPORT, LA
71109-6422

Practice Phone: 318-716-1717
Practice Fax: 318-716-1793

1740713791 — TONI THOMPSON
Practice Location Address:

4021 GREENWOOD RD
SHREVEPORT, LA
71109-6422

Practice Phone: 318-716-1717
Practice Fax: 318-716-1793

1619785649 — LILLIE HAYES
Practice Location Address:

4021 FOREST OAK DR
SHREVEPORT, LA
71109-8317

Practice Phone: 318-344-4328
Practice Fax:

1730013152 — DANA POTTER
Practice Location Address:

1845 LINE AVE STE A
SHREVEPORT, LA
71101-4611

Practice Phone: 318-670-7447
Practice Fax: 318-725-7448

1023489341 — DARIEN MITCHELL
Practice Location Address:

1845 LINE AVE STE A
SHREVEPORT, LA
71101-4611

Practice Phone: 318-670-7447
Practice Fax: 318-725-7448

Directions to “BROOKYS HAVEN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.