Provider Demographics
NPI:1841920451
Name:HUGHES, SHASTIDY B
Entity type:Individual
Prefix:
First Name:SHASTIDY
Middle Name:B
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 MACKEY PL STE 119
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2527
Mailing Address - Country:US
Mailing Address - Phone:318-771-7707
Mailing Address - Fax:318-383-6685
Practice Address - Street 1:2715 MACKEY PL STE 119
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2527
Practice Address - Country:US
Practice Address - Phone:318-771-7707
Practice Address - Fax:318-383-6685
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health