Provider Demographics
NPI:1407638059
Name:BRENTWOOD ACQUISITION SHREVEPORT, INC
Entity Type:Organization
Organization Name:BRENTWOOD ACQUISITION SHREVEPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-210-3855
Mailing Address - Street 1:2500 CENTENARY BLVD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2468
Mailing Address - Country:US
Mailing Address - Phone:318-210-3855
Mailing Address - Fax:
Practice Address - Street 1:1006 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4103
Practice Address - Country:US
Practice Address - Phone:318-210-3855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty