Basic Information
| Provider Information | |||||||||
| NPI: | 1144307034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METROPOLITAN CIRCLES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3510 LINWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711034512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186364194 | ||||||||
| FaxNumber: | 3186364126 | ||||||||
| Practice Location | |||||||||
| Address1: | 3510 LINWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711034512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186364194 | ||||||||
| FaxNumber: | 3186364196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | THROWER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3186364194 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | LA | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0855X | LA | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | LA | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 251S00000X | 1553620 | LA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1553620 | 05 | LA | MEDICAID |