Provider Demographics
NPI: | 1174042808 |
---|---|
Name: | FAMILY SOLUTIONS PEDIATRIC THERAPY, LLC |
Entity Type: | Organization |
Organization Name: | FAMILY SOLUTIONS PEDIATRIC THERAPY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SCOTT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHELBY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD, LPC, LMFT |
Authorized Official - Phone: | 318-322-6500 |
Mailing Address - Street 1: | 1103 HUDSON LN |
Mailing Address - Street 2: | |
Mailing Address - City: | MONROE |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 71201-6035 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 318-322-6500 |
Mailing Address - Fax: | 318-322-5118 |
Practice Address - Street 1: | 1300 HUDSON LN |
Practice Address - Street 2: | |
Practice Address - City: | MONROE |
Practice Address - State: | LA |
Practice Address - Zip Code: | 71201-6066 |
Practice Address - Country: | US |
Practice Address - Phone: | 318-322-6500 |
Practice Address - Fax: | 318-322-5118 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-09-13 |
Last Update Date: | 2017-09-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 101YM0800X, 103K00000X, 103T00000X, 1041C0700X, 106H00000X, 106S00000X, 133V00000X, 2084P0800X, 224Z00000X, 225100000X, 225200000X, 225X00000X, 235Z00000X | ||
LA | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |