Basic Information
| Provider Information | |||||||||
| NPI: | 1740645845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THROWER | ||||||||
| FirstName: | ANTONIO | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 912 WINDHAM CT | ||||||||
| Address2: | |||||||||
| City: | BOSSIER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188053334 | ||||||||
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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: | 12/16/2015 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6178 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.