Active NPI
Deandrea Graham
- Mental Health Counselor
- Shreveport, LA
National Provider Identifier
1437516382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 009322801
- Practice address
- 543 Stoner Ave
Shreveport, LA 71101-4122 - Phone
- (318) 673-9901
- NPI assigned
- Jan 23, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Mental Health Counselor | 101YM0800X | 009322801 | LA | Primary |
Addresses
Primary practice location
543 Stoner Ave
Shreveport, LA 71101-4122
Mailing address
543 Stoner Ave
Shreveport, LA 71101-4122
Phone (318) 673-9901
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009322801 | LA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562803200000",
"number": "1437516382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "543 STONER AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014122",
"telephone_number": "318-673-9901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "543 STONER AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014122",
"telephone_number": "318-673-9901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "DEANDREA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-23",
"last_updated": "2019-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "LA",
"license": "009322801",
"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 Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.