NPIMap

Organization Active NPI

Shining Star Professional Services Inc

  • Social Worker
  • Shreveport, LA
National Provider Identifier
1952471609
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
4322 Issued in LA
Legal business name
SHINING STAR PROFESSIONAL SERVICES INC
Practice address
9050 Youree Drive
#1004
Shreveport, LA 71115
Phone
(318) 795-8055
Fax
(318) 635-7100
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Akee LJ Jackson, LCSWNPI 1922178854
Title
Owner
Phone
(318) 795-8055

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
Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 104100000X 4322 LA Primary

Addresses

Primary practice location

9050 Youree Drive
#1004
Shreveport, LA 71115

Mailing address

9050 Youree Drive
#1004
Shreveport, LA 71115
Phone (318) 795-8055

Other identifiers 2

IdentifierTypeStateIssuer
1562904MedicaidLA
5X968OtherLAINDIVIDUAL MEDICARE #

National Provider Directory

National Provider Directory

Locations

4615 Monkhouse Dr
Ste A12
Shreveport, LA 71109
Phone (318) 631-6255

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952471609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9050 YOUREE DRIVE",
            "address_2": "#1004",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71115",
            "telephone_number": "318-795-8055",
            "fax_number": "318-635-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9050 YOUREE DRIVE",
            "address_2": "#1004",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71115",
            "telephone_number": "318-795-8055",
            "fax_number": "318-635-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING STAR PROFESSIONAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "AKEE",
        "authorized_official_middle_name": "LJ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-795-8055",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": "LA",
            "license": "4322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1562904",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL MEDICARE #",
            "identifier": "5X968",
            "state": "LA"
        }
    ],
    "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 22, 2020; 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.