Provider Demographics
NPI:1770225120
Name:ARK-LA-TEX SOUND MINDS, LLC
Entity Type:Organization
Organization Name:ARK-LA-TEX SOUND MINDS, LLC
Other - Org Name:ARK-LA-TEX SOUND MINDS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:STIGER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:903-650-1155
Mailing Address - Street 1:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:QUEEN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75572-0921
Mailing Address - Country:US
Mailing Address - Phone:903-650-1155
Mailing Address - Fax:
Practice Address - Street 1:2920 KNIGHT ST STE 102
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2412
Practice Address - Country:US
Practice Address - Phone:903-650-1155
Practice Address - Fax:318-374-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2581082Medicaid