Provider Demographics
NPI:1598059719
Name:BOLLAM, SATYAPRABHA REDDY (LMFT)
Entity Type:Individual
Prefix:
First Name:SATYAPRABHA
Middle Name:REDDY
Last Name:BOLLAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4518
Mailing Address - Country:US
Mailing Address - Phone:318-458-7713
Mailing Address - Fax:318-754-4195
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4518
Practice Address - Country:US
Practice Address - Phone:318-458-7713
Practice Address - Fax:318-754-4195
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4362101YP2500X
TX5863101YA0400X
TX12182101YP2500X
TX4613106H00000X
LA1177106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist