Basic Information
Provider Information
NPI: 1033556261
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RICE
FirstName: SARA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1310 N HEARNE AVE
Address2:  
City: SHREVEPORT
State: LA
PostalCode: 711076516
CountryCode: US
TelephoneNumber: 3186765111
FaxNumber: 3186765021
Practice Location
Address1: 1310 N HEARNE AVE
Address2:  
City: SHREVEPORT
State: LA
PostalCode: 711076516
CountryCode: US
TelephoneNumber: 3186765111
FaxNumber: 3186765021
Other Information
ProviderEnumerationDate: 05/29/2013
LastUpdateDate: 09/16/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X4957LAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


Home