Basic Information
| Provider Information | |||||||||
| NPI: | 1568509255 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST LOUISIANA BEHAVIORAL HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 BERT KOUNS INDUSTRIAL LOOP | ||||||||
| Address2: | LOT 870 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711295056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186886441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1310 N HEARNE AVE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711076516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186765111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GOAD | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3186765111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.