Organization
WK BEHAVIORAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
2510 BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71118-3119
(318) 212-5200
(318) 212-5595
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8574
(318) 212-4153
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1189197
—
LA
Enumeration date
08/08/2008
Last updated
06/08/2012
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