Provider Demographics
NPI:1811431893
Name:ALTERNATIVE INTERVENTION
Entity type:Organization
Organization Name:ALTERNATIVE INTERVENTION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNOM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-BACS
Authorized Official - Phone:318-869-1899
Mailing Address - Street 1:2800 YOUREE DR.
Mailing Address - Street 2:STE. #482A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104
Mailing Address - Country:US
Mailing Address - Phone:318-734-0153
Mailing Address - Fax:844-664-0650
Practice Address - Street 1:2800 YOUREE DR.
Practice Address - Street 2:STE. #482A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-734-0153
Practice Address - Fax:844-664-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-11
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health