Organization
MENTOR HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERENCE TRAMMELL (CEO)
(318) 464-6494
Entity
Organization
Contact information
Practice address
205 JORDAN ST, SHREVEPORT, LA 71101-4975
(318) 562-3508
Mailing address
205 JORDAN ST, SHREVEPORT, LA 71101-4975
(318) 562-3508
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/25/2026
Last updated
06/22/2026
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