NPIMap

Organization Active NPI

Source of Solutions Counseling Service, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bossier City, LA
National Provider Identifier
1013363654
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SOURCE OF SOLUTIONS COUNSELING SERVICE, LLC
Practice address
2285 Benton Rd Ste D103
Bossier City, LA 71111-3465
Phone
(318) 584-7197
Fax
(318) 584-7080
NPI assigned
May 12, 2016
Last updated
Jun 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Roslyn StumonNPI 1427423490
Title
Owner/Administrator
Phone
(318) 584-7197

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Community/Behavioral Health Agency 251S00000X LA

Addresses

Primary practice location

2285 Benton Rd Ste D103
Bossier City, LA 71111-3465

Mailing address

2285 Benton Rd Ste D103
Bossier City, LA 71111-3465
Phone (318) 584-7197

Other practice location 1

153 S Elm St Ste 200
Haughton, LA 71037-9609
Phone (318) 615-5013

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180511000292 LA Part B Supplier - Clinic/Group Practice 2860756244 Receives reassigned benefits from 1 practitioner
Practice locations: Bossier City, LA

National Provider Directory

National Provider Directory

Locations

2285 Benton Rd
Ste D103B
Bossier City, LA 71111

153 S Elm St
Ste 200
Haughton, LA 71037
Phone (318) 615-5013

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686614400000",
    "number": "1013363654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 BENTON RD STE D103",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113465",
            "telephone_number": "318-584-7197",
            "fax_number": "318-584-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2285 BENTON RD STE D103",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113465",
            "telephone_number": "318-584-7197",
            "fax_number": "318-584-7080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "153 S Elm St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Haughton",
            "state": "LA",
            "postal_code": "710379609",
            "country_code": "US",
            "telephone_number": "318-615-5013",
            "fax_number": "318-615-5031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOURCE OF SOLUTIONS COUNSELING SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-12",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A",
        "authorized_official_last_name": "STUMON",
        "authorized_official_first_name": "ROSLYN",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "318-584-7197",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "LA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.