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Organization
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Active
Organization
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Active
Other names
LSU Health Shreveport dba Allied Health Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
REVA LATISHA MATTHIEW MBA (DIRECTOR OF CLINICAL MGMT SYSTEM)
(318) 813-2962
Entity
Organization
Contact information
Practice address
1450 CLAIBORNE AVE, SHREVEPORT, LA 71103-4204
(318) 813-2970
(318) 813-2975
Mailing address
1450 CLAIBORNE AVE, SHREVEPORT, LA 71103-4204
(318) 813-2962
(318) 813-2975
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/07/2021
Last updated
01/07/2021
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