| Vibrant Minds Therapy & Consulting Llc | |
|
820 Jordan St Ste 509 Shreveport LA 71101-4526 | |
| (318) 242-1441 | |
| (318) 300-1130 |
| Full Name | Vibrant Minds Therapy & Consulting Llc |
|---|---|
| Speciality | Social Worker |
| Location | 820 Jordan St Ste 509, Shreveport, Louisiana |
| Authorized Official Name and Position | Jessica Smith (CEO) |
| Authorized Official Contact | 3182421441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vibrant Minds Therapy & Consulting Llc 820 Jordan St Ste 509 Shreveport LA 71101-4526 Ph: (318) 242-1441 | Vibrant Minds Therapy & Consulting Llc 820 Jordan St Ste 509 Shreveport LA 71101-4526 Ph: (318) 242-1441 |
| NPI Number | 1629663620 |
|---|---|
| Provider Enumeration Date | 03/02/2021 |
| Last Update Date | 06/16/2021 |
| Certification Date | 06/16/2021 |
| Medicare PECOS PAC ID | 4385045392 |
|---|---|
| Medicare Enrollment ID | O20210629000676 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629663620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jessica Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639529118 PECOS PAC ID: 6103227111 Enrollment ID: I20210629001129 |
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