Basic Information
| Provider Information | |||||||||
| NPI: | 1871813717 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUPERIOR COUNSELING SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2620 CENTENARY BLVD | ||||||||
| Address2: | BLDG 3 STE 312 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711043356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186819935 | ||||||||
| FaxNumber: | 3186819938 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 CENTENARY BLVD | ||||||||
| Address2: | BLDG 3 STE 312 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711043356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186819935 | ||||||||
| FaxNumber: | 3186819938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 06/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | BODEN | ||||||||
| AuthorizedOfficialFirstName: | KATRINA | ||||||||
| AuthorizedOfficialMiddleName: | OVALETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3186819935 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M ED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.