Basic Information
| Provider Information | |||||||||
| NPI: | 1982058756 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUTUMN CREEK HEALTH SOLUTIONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2924 KNIGHT ST | ||||||||
| Address2: | SUITE 426 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711052415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187543560 | ||||||||
| FaxNumber: | 3187790439 | ||||||||
| Practice Location | |||||||||
| Address1: | 2924 KNIGHT ST | ||||||||
| Address2: | SUITE 426 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711052415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187543560 | ||||||||
| FaxNumber: | 3187790439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2016 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | TERRELL | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 3184533895 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 251S00000X | BH0011664 | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.