Provider Demographics
NPI:1063887594
Name:CARR, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 OLIVE ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2312
Mailing Address - Country:US
Mailing Address - Phone:318-429-7500
Mailing Address - Fax:318-227-6179
Practice Address - Street 1:520 OLIVE ST
Practice Address - Street 2:STE. 201
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2312
Practice Address - Country:US
Practice Address - Phone:318-429-7500
Practice Address - Fax:318-227-6179
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional