Provider Demographics
NPI:1598324287
Name:ELITE CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ELITE CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WYONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-BACS
Authorized Official - Phone:318-426-1708
Mailing Address - Street 1:2620 CENTENARY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3350
Mailing Address - Country:US
Mailing Address - Phone:318-946-8527
Mailing Address - Fax:318-946-8527
Practice Address - Street 1:2620 CENTENARY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3350
Practice Address - Country:US
Practice Address - Phone:318-946-8527
Practice Address - Fax:318-946-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty