| Center For Psychological Trauma, Llc | |
|
820 Jordan St Ste. 570 Shreveport LA 71101-4518 | |
| (318) 221-4455 | |
| (318) 221-4459 |
| Full Name | Center For Psychological Trauma, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 820 Jordan St, Shreveport, Louisiana |
| Authorized Official Name and Position | Frank William White (OWNER) |
| Authorized Official Contact | 3182214455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Psychological Trauma, Llc 820 Jordan St Ste. 570 Shreveport LA 71101-4518 Ph: (318) 221-4455 | Center For Psychological Trauma, Llc 820 Jordan St Ste. 570 Shreveport LA 71101-4518 Ph: (318) 221-4455 |
| NPI Number | 1588853048 |
|---|---|
| Provider Enumeration Date | 10/22/2007 |
| Last Update Date | 11/09/2007 |
| Medicare PECOS PAC ID | 0143240838 |
|---|---|
| Medicare Enrollment ID | O20051123000541 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588853048 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 8807 (Louisiana) | Primary |
| Provider Name | Frank W White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144285115 PECOS PAC ID: 7911962212 Enrollment ID: I20050805000116 |
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