Organization
SHREVEPORT MENTAL HEALTH
Active
Parent organization
STATE OF LOUISIANA
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF LOUISIANA
Authorized official
ROBENA PETTERWAY (MHC MANAGER 4)
(318) 676-5111
Entity
Organization
Contact information
Practice address
1310 N HEARNE AVE, SHREVEPORT, LA 71107-6516
(318) 676-5111
(318) 676-5077
Mailing address
1310 N HEARNE AVE, SHREVEPORT, LA 71107-6516
(318) 676-5111
(318) 676-5077
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/07/2008
Last updated
05/07/2008
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