Organization
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Active
Other names
Allied Health Clinics, Children's Center
Organization subpart
No
Provider details
NPI number
Authorized official
REVA MATTHIEW ROBINSON MBA (DIRECTOR OF CLIN MGMT SYSTEM)
(318) 813-2962
Entity
Organization
Contact information
Practice address
1450 CLAIBORNE AVE, SHREVEPORT, LA 71103-4204
(318) 813-2962
(318) 813-2981
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174173
—
LA
05
—
1884324
—
LA
Enumeration date
11/18/2009
Last updated
07/31/2020
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