Organization
MMO OF SHREVEPORT, LLC
Active
Other names
Antares Behavioral Health, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT L MILLER (CEO)
(225) 293-6774
Entity
Organization
Contact information
Practice address
3341 YOUREE DR, SUITE 102, SHREVEPORT, LA 71105-2149
(318) 688-6228
(318) 688-6466
Mailing address
728 NORTH BLVD, BATON ROUGE, LA 70802-5724
(225) 293-6774
(225) 291-9299
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
LA
Other
Enumeration date
06/05/2006
Last updated
10/03/2008
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