Provider Demographics
NPI:1932246360
Name:RILEY, TONYA MCBROOM (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:MCBROOM
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3821
Mailing Address - Country:US
Mailing Address - Phone:318-393-9690
Mailing Address - Fax:
Practice Address - Street 1:5902 BUNCOMBE RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-4004
Practice Address - Country:US
Practice Address - Phone:318-670-8898
Practice Address - Fax:318-300-3772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA979106H00000X
LA2979101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty