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Organization

WK BEHAVIORAL HEALTH MEDICAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization

Contact information

Practice address
2300 HOSPITAL DR, SUITE 340, BOSSIER CITY, LA 71111-2394
(318) 212-7461
(318) 212-7465
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8946
(318) 212-4153

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2084P0804X
Child & Adolescent Psychiatry Physician

Other

Enumeration date
07/11/2011
Last updated
10/16/2012
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