Provider Demographics
NPI:1003371626
Name:ROAN COUNSELING, LLC
Entity Type:Organization
Organization Name:ROAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNCELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROAN
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:FLENNIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-455-6008
Mailing Address - Street 1:PO BOX 53032
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-3032
Mailing Address - Country:US
Mailing Address - Phone:318-798-4539
Mailing Address - Fax:318-798-4601
Practice Address - Street 1:1455 E BERT KOUNS INDUSTRIAL LOOP # 102
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5634
Practice Address - Country:US
Practice Address - Phone:318-798-4444
Practice Address - Fax:318-795-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)