NPI 1801289020 · live from the CMS NPI Registry
Behavioral Specialists Of La
Psychologist, Clinical in Shreveport, LA. National Provider Identifier 1801289020, active.
NPI record
| NPI | 1801289020 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Clinical 103TC0700X |
| Practice location | 925 Olive St, Shreveport, LA 71104 |
| Practice phone | 318-300-3560 |
| Mailing address | 925 Olive Street, Shreveport, LA 71104 |
| Enumerated | March 12, 2015 |
| Last updated | February 14, 2018 |
| Authorized official | Amy Bamburg, Coo/Agent |
| Other names | Behavioral Specialists Of Louisiana |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst | 103K00000X | — (LA) |
| Early Intervention Provider Agency | 252Y00000X | — |
| Psychologist, Clinical primary | 103TC0700X | — (LA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.