1568948396 NPI number — SCERE'S MEDIATION & COUNSELING SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568948396 NPI number — SCERE'S MEDIATION & COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
SCERE'S MEDIATION & COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568948396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIVIAN
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71082-3503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-220-6087
Provider Business Mailing Address Fax Number:
318-216-5261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 MARSHALL ST STE 625
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71101-3652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-220-6087
Provider Business Practice Location Address Fax Number:
318-216-5261
Provider Enumeration Date:
07/16/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCER
Authorized Official First Name:
RUBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER & PC-S
Authorized Official Telephone Number:
318-220-6087

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  939 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)