| Mind Rehabilitation & Resource Center | |
|
1513 Line Ave Ste 135 Shreveport LA 71101-4621 | |
| (318) 828-1455 | |
| Not Available |
| Full Name | Mind Rehabilitation & Resource Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1513 Line Ave Ste 135, Shreveport, Louisiana |
| Authorized Official Name and Position | Kamique Michelle Johnson (MENTAL HEALTH PROFESSIONAL) |
| Authorized Official Contact | 3187802828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Rehabilitation & Resource Center 2923 Oak Forest Ln Shreveport LA 71107-5802 Ph: (318) 780-2828 | Mind Rehabilitation & Resource Center 1513 Line Ave Ste 135 Shreveport LA 71101-4621 Ph: (318) 828-1455 |
| NPI Number | 1083073217 |
|---|---|
| Provider Enumeration Date | 02/16/2016 |
| Last Update Date | 02/16/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083073217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 19320000X/101YM0800X (Louisiana) | Primary |
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