Active NPI
Mark Nettles, LPC
- Professional Counselor
- Shreveport, LA
National Provider Identifier
1679248025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5331
- Practice address
- 748 Cecile PL
Shreveport, LA 71106-1202 - Phone
- (318) 525-6979
- NPI assigned
- Aug 9, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5331 | LA | Primary |
Addresses
Primary practice location
748 Cecile PL
Shreveport, LA 71106-1202
Mailing address
748 Cecile PL
Shreveport, LA 71106-1202
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 |
|---|---|---|---|
| 5331 | LA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Milestones Counseling Center, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Shreveport, LA
- NPI 1215335880
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628467200000",
"number": "1679248025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "748 CECILE PL",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711061202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "748 CECILE PL",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711061202",
"telephone_number": "318-525-6979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NETTLES",
"first_name": "MARK",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-08-09",
"last_updated": "2021-08-09",
"certification_date": "2021-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "LA",
"license": "5331",
"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 Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.