Mmo of Shreveport, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MMO OF SHREVEPORT, LLC

Practice address

3341 Youree Dr
Suite 102
Shreveport, LA 71105-2149

Phone

(318) 688-6228

Fax

(318) 688-6466

NPI assigned

Jun 5, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Robert L Miller

Title

Ceo

Phone

(225) 293-6774

Specialties & licenses 1

Addresses

Other names 1

• Antares Behavioral Health, LLC Former legal business name

Locations

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222992000000",
    "number": "1124067145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "728 NORTH BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708025724",
            "telephone_number": "225-293-6774",
            "fax_number": "225-291-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3341 YOUREE DR",
            "address_2": "SUITE 102",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052149",
            "telephone_number": "318-688-6228",
            "fax_number": "318-688-6466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMO OF SHREVEPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2008-10-03",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-293-6774",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Antares Behavioral Health, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Tyechia Mitchell, MHS
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• MLD and Associates
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• Mobile X-Ray Services LLC
• Mobile X-Ray Services of Shreveport Bossier Inc
• Glenn F. Mobley Sr., COTA
• Ashish G Modi, PHARM.D

• Mental Health Clinic/Center (Including Community Mental Health Center) in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2008; 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.