Provider Demographics
NPI:1124493218
Name:STRONG, MARY (LPC-S, RPT, CAS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STRONG
Suffix:
Gender:F
Credentials:LPC-S, RPT, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 ACKLEN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3901
Mailing Address - Country:US
Mailing Address - Phone:318-670-8858
Mailing Address - Fax:318-670-8947
Practice Address - Street 1:3018 OLD MINDEN RD STE 1206
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2543
Practice Address - Country:US
Practice Address - Phone:318-350-7676
Practice Address - Fax:318-350-6767
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86068101YM0800X
LA7144101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1043842750Medicaid
TX28327407Medicaid