NPIMap

Organization Active NPI

Mind Rehabilitation & Resource Center

  • Community/Behavioral Health Agency
  • Bossier City, LA
National Provider Identifier
1972965556
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MIND REHABILITATION & RESOURCE CENTER
Practice address
1259 Fullilove Dr
Bossier City, LA 71112-3340
Phone
(318) 200-7859
NPI assigned
Mar 23, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Ms. Tonya M Riley, LPC-S
Title
Clinical Supervisor
Phone
(318) 828-1455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1259 Fullilove Dr
Bossier City, LA 71112-3340

Mailing address

1259 Fullilove Dr
Bossier City, LA 71112-3340
Phone (318) 200-7859

Other identifiers 1

IdentifierTypeStateIssuer
1851688105MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Mind Rehabilitation Resource Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1972965556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1259 FULLILOVE DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711123340",
            "telephone_number": "318-200-7859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1259 FULLILOVE DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711123340",
            "telephone_number": "318-200-7859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND REHABILITATION & RESOURCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-23",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL SUPERVISOR",
        "authorized_official_telephone_number": "318-828-1455",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC-S"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851688105",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; 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.