Provider Demographics
NPI:1790471886
Name:HCO BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:HCO BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLPC
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PLPC
Authorized Official - Phone:318-525-8706
Mailing Address - Street 1:2021 N KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4714
Mailing Address - Country:US
Mailing Address - Phone:318-525-8706
Mailing Address - Fax:
Practice Address - Street 1:2021 N KIRKWOOD DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-4714
Practice Address - Country:US
Practice Address - Phone:318-525-8706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty