Provider Demographics
NPI:1356804694
Name:SHREVEPORT BOSSIER LA COUNSELING SERVICES
Entity type:Organization
Organization Name:SHREVEPORT BOSSIER LA COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSION COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:BLEAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:318-613-6912
Mailing Address - Street 1:7109 PINE OAK LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-3377
Mailing Address - Country:US
Mailing Address - Phone:318-613-6912
Mailing Address - Fax:
Practice Address - Street 1:2285 BENTON RD STE 203
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7933
Practice Address - Country:US
Practice Address - Phone:318-613-6912
Practice Address - Fax:318-666-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health