NPIMap

Organization Active NPI

Reef Wellness

  • Professional Counselor
  • Shreveport, LA
National Provider Identifier
1417574237
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
REEF WELLNESS
Practice address
3616 Youree Dr
Shreveport, LA 71105-2122
Phone
(318) 779-0104
Fax
(318) 421-3193
NPI assigned
Jun 27, 2020
Last updated
Feb 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Authorized official

Name
Trena L Edwards, MA, LPC-SNPI 1699390302
Title
Therapist
Phone
(318) 935-9585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

3616 Youree Dr
Shreveport, LA 71105-2122

Mailing address

10010 Willowwick CT
Shreveport, LA 71118-4521
Phone (318) 935-9585

National Provider Directory

National Provider Directory

Locations

1810 E 70th St
Shreveport, LA 71105

3616 Youree Dr
Shreveport, LA 71105
Phone (318) 309-7409

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1593216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1417574237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10010 WILLOWWICK CT",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711184521",
            "telephone_number": "318-935-9585",
            "fax_number": "318-421-3193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3616 YOUREE DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711052122",
            "telephone_number": "318-779-0104",
            "fax_number": "318-421-3193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REEF WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-27",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "TRENA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "318-935-9585",
        "authorized_official_credential": "MA, LPC-S"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "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 Feb 21, 2024; 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.