| NPI | 1023075017 |
|---|---|
| Former Legal Business Name | SHREVEPORT BEHAVIORAL HEALTH CLINIC |
| Entity Type | Organization |
| Authorized Contact | ALLIE D. ALLEN Administrative Program Manager 318-676-5111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: LA 115) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2012-02-23 |