| Beyond The Brick Wall | |
|
820 Jordan St Ste 550 Shreveport LA 71101-4526 | |
| (318) 734-9022 | |
| Not Available |
| Full Name | Beyond The Brick Wall |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 820 Jordan St Ste 550, Shreveport, Louisiana |
| Authorized Official Name and Position | Robert Nowlin Gardner (PRACTICE MANAGER) |
| Authorized Official Contact | 3187348492 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beyond The Brick Wall 820 Jordan St Ste 550 Shreveport LA 71101-4526 Ph: (318) 734-9022 | Beyond The Brick Wall 820 Jordan St Ste 550 Shreveport LA 71101-4526 Ph: (318) 734-9022 |
| NPI Number | 1730908104 |
|---|---|
| Provider Enumeration Date | 10/03/2024 |
| Last Update Date | 10/03/2024 |
| Certification Date | 10/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730908104 | NPI | - | NPPES |
| 1548901044 | Other | LA | NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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