| Changing Behavior Services, Llc | |
|
1434 Hawn Ave Ste. 12 Shreveport LA 71107-6508 | |
| (318) 675-0224 | |
| (318) 675-0226 |
| Full Name | Changing Behavior Services, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1434 Hawn Ave, Shreveport, Louisiana |
| Authorized Official Name and Position | Pamela Michelle Phillips (OWNER) |
| Authorized Official Contact | 3186175869 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Behavior Services, Llc Po Box 7875 Shreveport LA 71137-7875 Ph: (318) 675-0224 | Changing Behavior Services, Llc 1434 Hawn Ave Ste. 12 Shreveport LA 71107-6508 Ph: (318) 675-0224 |
| NPI Number | 1902103617 |
|---|---|
| Provider Enumeration Date | 02/15/2011 |
| Last Update Date | 06/02/2022 |
| Certification Date | 06/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902103617 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 10111532#MVA42 (Louisiana) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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