| Behavioral Specialists Of Louisiana | |
|
925 Olive St Shreveport LA 71104-2103 | |
| (318) 300-3560 | |
| (318) 300-3561 |
| Full Name | Behavioral Specialists Of Louisiana |
|---|---|
| Speciality | Psychologist |
| Location | 925 Olive St, Shreveport, Louisiana |
| Authorized Official Name and Position | Amy C Bamburg (COO/AGENT) |
| Authorized Official Contact | 3184424498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioral Specialists Of Louisiana 925 Olive Street Shreveport LA 71104 Ph: (318) 300-3560 | Behavioral Specialists Of Louisiana 925 Olive St Shreveport LA 71104-2103 Ph: (318) 300-3560 |
| NPI Number | 1801289020 |
|---|---|
| Provider Enumeration Date | 03/12/2015 |
| Last Update Date | 02/14/2018 |
| Medicare PECOS PAC ID | 4486973229 |
|---|---|
| Medicare Enrollment ID | O20150429001808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801289020 | NPI | - | NPPES |
| 2384066 | Medicaid | LA |
| Provider Name | Jerald W Bamburg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598926644 PECOS PAC ID: 7113094244 Enrollment ID: I20080916000093 |
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