Provider Demographics
NPI:1043842750
Name:MARY S STRONG CREATIVE COMMUNITY COUNSELING
Entity Type:Organization
Organization Name:MARY S STRONG CREATIVE COMMUNITY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SOSONYA
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:RSW, LPC, RPT, CAS
Authorized Official - Phone:318-288-2686
Mailing Address - Street 1:731 ACKLEN ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3901
Mailing Address - Country:US
Mailing Address - Phone:318-288-2686
Mailing Address - Fax:
Practice Address - Street 1:719 S AUSTIN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6714
Practice Address - Country:US
Practice Address - Phone:318-350-6767
Practice Address - Fax:318-350-6767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE COMMUNITY COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-11
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1043842750Medicaid
TX2832407Medicaid
TX28327407Medicaid