| Wk Center For Psychiatric Support | |
|
1111 Line Ave 3rd Floor Tower 2 Shreveport LA 71101-3981 | |
| (318) 716-4610 | |
| (318) 716-4690 |
| Full Name | Wk Center For Psychiatric Support |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1111 Line Ave 3rd Floor Tower 2, Shreveport, Louisiana |
| Authorized Official Name and Position | Greg J. Gavin (NETWORK ADMINISTRATOR) |
| Authorized Official Contact | 3182124232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Center For Psychiatric Support 1111 Line Ave 3rd Floor Tower 2 Shreveport LA 71101-3981 Ph: (318) 716-4610 | Wk Center For Psychiatric Support 1111 Line Ave 3rd Floor Tower 2 Shreveport LA 71101-3981 Ph: (318) 716-4610 |
| NPI Number | 1609194356 |
|---|---|
| Provider Enumeration Date | 05/05/2010 |
| Last Update Date | 02/17/2017 |
| Medicare PECOS PAC ID | 6406972645 |
|---|---|
| Medicare Enrollment ID | O20100925000006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609194356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Tony A Hanna |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912039116 PECOS PAC ID: 8527024793 Enrollment ID: I20041209000084 |
| Provider Name | Jason M Broussard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376744771 PECOS PAC ID: 2769508902 Enrollment ID: I20100925000012 |
| Provider Name | Arien M Ward |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578702643 PECOS PAC ID: 5395870133 Enrollment ID: I20101115000453 |
| Provider Name | Devanshi Jani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770794083 PECOS PAC ID: 8325212293 Enrollment ID: I20111111000228 |
| Provider Name | Claudia V Orellana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417167842 PECOS PAC ID: 4981878378 Enrollment ID: I20111121000865 |
| Provider Name | Matthew S Menard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407148992 PECOS PAC ID: 9032403753 Enrollment ID: I20190703000927 |
| Provider Name | Shawn E. Mcneil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255775052 PECOS PAC ID: 1951607183 Enrollment ID: I20191119001046 |
| Provider Name | Rebecca Elizabeth Pistorius |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518353671 PECOS PAC ID: 7416250279 Enrollment ID: I20210722003227 |
| Provider Name | Chandra Walker-target |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871214064 PECOS PAC ID: 6901274687 Enrollment ID: I20221130002840 |
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