NPIMap

Organization Active NPI

Mind Rehabilitation & Resource Center

  • Community/Behavioral Health Agency
  • Shreveport, LA
National Provider Identifier
1083073217
Registry record updated Feb 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
19320000X/101YM0800X Issued in LA
Legal business name
MIND REHABILITATION & RESOURCE CENTER
Practice address
1513 Line Ave Ste 135
Shreveport, LA 71101-4621
Phone
(318) 828-1455
NPI assigned
Feb 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2016

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

Authorized official

Name
Mrs. Kamique Michelle Johnson
Title
Mental Health Professional
Phone
(318) 780-2828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 19320000X/101YM0800X LA Primary

Addresses

Primary practice location

1513 Line Ave Ste 135
Shreveport, LA 71101-4621

Mailing address

2923 Oak Forest LN
Shreveport, LA 71107-5802
Phone (318) 780-2828

National Provider Directory

National Provider Directory
Tax ID family
Mind Rehabilitation Resource Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1455580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1083073217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2923 OAK FOREST LN",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711075802",
            "telephone_number": "318-780-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 LINE AVE STE 135",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014621",
            "telephone_number": "318-828-1455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND REHABILITATION & RESOURCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-16",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KAMIQUE",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "MENTAL HEALTH PROFESSIONAL",
        "authorized_official_telephone_number": "318-780-2828",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "LA",
            "license": "19320000X/101YM0800X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.