Basic Information
| Provider Information | |||||||||
| NPI: | 1699852004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MENTAL HEALTH SOLUTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2924 KNIGHT ST | ||||||||
| Address2: | BUILDING 4 SUITE 434 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711052413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186311122 | ||||||||
| FaxNumber: | 3186311166 | ||||||||
| Practice Location | |||||||||
| Address1: | 2924 KNIGHT ST | ||||||||
| Address2: | BUILDING 4 SUITE 434 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711052413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186311122 | ||||||||
| FaxNumber: | 3186311166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | STANFORD | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3186311122 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1939846 | 05 | LA | MEDICAID |