| Fallis Counseling Llc | |
|
5657 N Lakeshore Dr Shreveport LA 71107-9382 | |
| (318) 218-2360 | |
| (318) 668-7811 |
| Full Name | Fallis Counseling Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5657 N Lakeshore Dr, Shreveport, Louisiana |
| Authorized Official Name and Position | Jesse Fallis (OWNER) |
| Authorized Official Contact | 3182182360 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fallis Counseling Llc 5657 N Lakeshore Dr Shreveport LA 71107-9382 Ph: (318) 218-2360 | Fallis Counseling Llc 5657 N Lakeshore Dr Shreveport LA 71107-9382 Ph: (318) 218-2360 |
| NPI Number | 1376314385 |
|---|---|
| Provider Enumeration Date | 01/10/2024 |
| Last Update Date | 01/10/2024 |
| Certification Date | 01/10/2024 |
| Medicare PECOS PAC ID | 7618498965 |
|---|---|
| Medicare Enrollment ID | O20250304001057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376314385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | James A Burgos |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093466567 PECOS PAC ID: 7810411345 Enrollment ID: I20250407001628 |
| Provider Name | Jody L Waldo |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043873631 PECOS PAC ID: 5799209227 Enrollment ID: I20250407001713 |
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