Basic Information
| Provider Information | |||||||||
| NPI: | 1770938821 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUPERIOR COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9401 MONTWOOD CIR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185722899 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2620 CENTENARY BLVD STE 312 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711043358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186819935 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2016 | ||||||||
| LastUpdateDate: | 04/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | CARR-JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH PROFESSIONAL | ||||||||
| AuthorizedOfficialTelephone: | 3185722899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.