1790134864 NPI number — LOYALTY BEHAVIORAL COUNSELING

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 1790134864 NPI number — LOYALTY BEHAVIORAL COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOYALTY BEHAVIORAL COUNSELING
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:
LOYALTY HEALTH CARE SERVICES, LLC
Provider Other Organization Name Type Code:
3
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:
1790134864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29223
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:
71149-9223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 YOUREE DR STE 120
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:
71104-3667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-671-4341
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
FELECIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-572-0360

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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)





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