Provider Demographics
NPI:1710242805
Name:WILLIAMS COUNSELING SERVICES OF SHREVEPORT, LLC
Entity Type:Organization
Organization Name:WILLIAMS COUNSELING SERVICES OF SHREVEPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:318-219-9508
Mailing Address - Street 1:4300 YOUREE DR
Mailing Address - Street 2:SUITE 320-A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3329
Mailing Address - Country:US
Mailing Address - Phone:318-219-9508
Mailing Address - Fax:318-219-9514
Practice Address - Street 1:4300 YOUREE DR
Practice Address - Street 2:SUITE 320-A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-3329
Practice Address - Country:US
Practice Address - Phone:318-219-9508
Practice Address - Fax:318-219-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1692251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health