NPIMap

Organization Active NPI

Shreveport Mental Health

  • Mental Health Counselor
  • Shreveport, LA
National Provider Identifier
1184890337
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SHREVEPORT MENTAL HEALTH
Practice address
1310 N Hearne Ave
Shreveport, LA 71107-6516
Phone
(318) 676-5111
Fax
(318) 676-5077
NPI assigned
May 7, 2008
Organization subpart
Yes
Parent organization
STATE OF LOUISIANAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2008

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

Authorized official

Name
Robena Petterway
Title
MHC Manager 4
Phone
(318) 676-5111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

1310 N Hearne Ave
Shreveport, LA 71107-6516

Mailing address

1310 N Hearne Ave
Shreveport, LA 71107-6516
Phone (318) 676-5111

National Provider Directory

National Provider Directory
Tax ID family
Child Adolescent Mental31 organizations share this tax ID, including this one
Part of
Child Adolescent Mental

Other organizations with this tax ID 30

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

View all 30

Locations

1310 N Hearne Ave
Shreveport, LA 71107
Phone (318) 676-5111

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1184890337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 N HEARNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711076516",
            "telephone_number": "318-676-5111",
            "fax_number": "318-676-5077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 N HEARNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711076516",
            "telephone_number": "318-676-5111",
            "fax_number": "318-676-5077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHREVEPORT MENTAL HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF LOUISIANA",
        "enumeration_date": "2008-05-07",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "PETTERWAY",
        "authorized_official_first_name": "ROBENA",
        "authorized_official_title_or_position": "MHC MANAGER 4",
        "authorized_official_telephone_number": "318-676-5111"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "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 May 7, 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.