Provider Demographics
NPI:1376314385
Name:FALLIS COUNSELING LLC
Entity Type:Organization
Organization Name:FALLIS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:NCC LPC
Authorized Official - Phone:318-218-2360
Mailing Address - Street 1:5657 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-9382
Mailing Address - Country:US
Mailing Address - Phone:318-218-2360
Mailing Address - Fax:
Practice Address - Street 1:5657 N LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-9382
Practice Address - Country:US
Practice Address - Phone:318-218-2360
Practice Address - Fax:318-668-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)