Basic Information
| Provider Information | |||||||||
| NPI: | 1356715932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENNIS | ||||||||
| FirstName: | NATASHIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6009 FINANCIAL PLZ # 105 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711292615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186708858 | ||||||||
| FaxNumber: | 3186708947 | ||||||||
| Practice Location | |||||||||
| Address1: | 5963 CANADA CT | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186557084 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2015 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | CI6298 | LA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.