Provider Demographics
NPI:1912581687
Name:NORTH WEST LOUISIANA BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:NORTH WEST LOUISIANA BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/MENTAL HEALTH SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TALESHA
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-349-7730
Mailing Address - Street 1:7505 PINES RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3900
Mailing Address - Country:US
Mailing Address - Phone:318-683-4086
Mailing Address - Fax:
Practice Address - Street 1:1953 DANIEL ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3030
Practice Address - Country:US
Practice Address - Phone:318-349-7730
Practice Address - Fax:318-683-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty