Provider Demographics
NPI:1043516453
Name:S AND S PSYCHIATRY LLC
Entity Type:Organization
Organization Name:S AND S PSYCHIATRY LLC
Other - Org Name:WOMEN'S AND CHILDREN'S CENTER FOR MENTAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-550-3398
Mailing Address - Street 1:7591 FERN AVENUE
Mailing Address - Street 2:SUITE 1705
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5749
Mailing Address - Country:US
Mailing Address - Phone:318-550-3398
Mailing Address - Fax:
Practice Address - Street 1:7591 FERN AVENUE
Practice Address - Street 2:SUITE 1705
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5749
Practice Address - Country:US
Practice Address - Phone:318-550-3398
Practice Address - Fax:318-550-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2009242084P0800X
LA2015092084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1265466197OtherJASJIT SINGH NPI
LA1821208224OtherMANISH SARAN NPI