WK Psychology Specialty Center

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

WK PSYCHOLOGY SPECIALTY CENTER

Practice address

2508 Bert Kouns Industrial Loop
Suite 303
Shreveport, LA 71118-3133

Phone

(318) 212-5850

Fax

(318) 212-5855

NPI assigned

Mar 1, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Greg J. Gavin

Title

Network Administrator

Phone

(318) 212-4232

Specialties & licenses 1

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Willis Knighton Medical Center, Inc.

  dba WK Extended Care Center

  • Skilled Nursing Facility
  • Shreveport, LA
  • NPI 1144267451

  Member Of

  NPD member

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey T Overdyke, MD

  • Geriatric Psychiatry Physician
  • Shreveport, LA
  • NPI 1942414552
  NPD (past)
• Kendall Thomas Pilgreen, P.A.-C

  • Physician Assistant
  • Shreveport, LA
  • NPI 1174959779
  NPD (past)

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

{
    "created_epoch": "1267401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1144543489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 LOUISIANA AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013910",
            "telephone_number": "318-212-8574",
            "fax_number": "318-212-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 303",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-212-5850",
            "fax_number": "318-212-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK PSYCHOLOGY SPECIALTY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-01",
        "last_updated": "2012-06-08",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-4232",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK Pierremont Psychiatry
• WK Pierremont Womens Clinic
• WK Pines Road Family Medicine
• WK Pinnacle Gastroenterology
• WK Portico Pediatrics
• WK Radiation Oncology Services
• WK Red River Cardiovascular Surgeons
• WK Regional Perinatal Group
• WK Regional Transplant Center
• WK Rheumatology Pierremont

• Clinical Psychologist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Clinical Psychologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; 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.