Provider Demographics
NPI:1104168566
Name:ASSURED BEHAVIORAL CONCEPTS
Entity type:Organization
Organization Name:ASSURED BEHAVIORAL CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-626-7143
Mailing Address - Street 1:8921 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2144
Mailing Address - Country:US
Mailing Address - Phone:318-626-7143
Mailing Address - Fax:318-210-0358
Practice Address - Street 1:2912 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-4934
Practice Address - Country:US
Practice Address - Phone:318-626-7143
Practice Address - Fax:318-210-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4174101YP2500X
LABH0012249251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health