Individual provider Active NPI

Eddie Paul Millhollon, PH.D., LPC-S

  • Professional Counselor
  • Shreveport, LA
National Provider Identifier
1033426515
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
3716 Issued in LA
Practice address
820 Jordan St Ste 550
Shreveport, LA 71101-4526
Phone
(318) 734-9771
Fax
(318) 383-6653
NPI assigned
Sep 7, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 3716 LA Primary

Addresses

Primary practice location

820 Jordan St Ste 550
Shreveport, LA 71101-4526

Mailing address

820 Jordan St Ste 550
Shreveport, LA 71101-4526
Phone (318) 734-9771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231215002353 LA Practitioner - Mental Health Counselor 8325497308 Practice locations: Shreveport, LA

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

820 Jordan St
Suite 550
Shreveport, LA 71101-4526
Phone (318) 734-9771

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3716LAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Beyond the Brick Wall CurrentSince Oct 6, 2024 Accepting new patients
Linda Grayson LCSW LLC PastSince Jan 29, 2023 Accepting new patients
Center for Psychological Trauma, LLC PastSince Jun 13, 2005 Accepting new patients

Locations

820 Jordan St
Ste 550
Shreveport, LA 71101
Phone (318) 734-8492

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1283817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1033426515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 JORDAN ST STE 550",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014526",
            "telephone_number": "318-734-9771",
            "fax_number": "318-383-6653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 JORDAN ST STE 550",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014526",
            "telephone_number": "318-734-9771",
            "fax_number": "318-383-6653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLHOLLON",
        "first_name": "EDDIE",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "PH.D., LPC-S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-07",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "3716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.