1740339571 NPI number — MRS. SHELLEY WHITEHEAD BOOKER MSW, LCSW, ACSW

Table of content: MRS. SHELLEY WHITEHEAD BOOKER MSW, LCSW, ACSW (NPI 1740339571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740339571 NPI number — MRS. SHELLEY WHITEHEAD BOOKER MSW, LCSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOOKER
Provider First Name:
SHELLEY
Provider Middle Name:
WHITEHEAD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, ACSW
Provider Gender Code:
F

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:
1740339571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2827 LONG LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71106-8423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-798-0668
Provider Business Mailing Address Fax Number:
318-795-9840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 JORDAN ST
Provider Second Line Business Practice Location Address:
SUITE 511
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71101-4518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-220-7500
Provider Business Practice Location Address Fax Number:
318-220-7000
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3300 , 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)





Copyright © 2007-2025 www.npivalidator.com