Basic Information
| Provider Information | |||||||||
| NPI: | 1821530973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | RHONDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MASTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N THOMAS DR | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711076503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184248345 | ||||||||
| FaxNumber: | 3184244417 | ||||||||
| Practice Location | |||||||||
| Address1: | 7505 PINES RD STE 1200I | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184248345 | ||||||||
| FaxNumber: | 3184244417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2016 | ||||||||
| LastUpdateDate: | 07/14/2018 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.