Provider Demographics
NPI:1992950828
Name:METROPOLITAN CIRCLES, LLC
Entity type:Organization
Organization Name:METROPOLITAN CIRCLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAWANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CALHOUN-BEAUDION
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:318-636-4194
Mailing Address - Street 1:3510 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4512
Mailing Address - Country:US
Mailing Address - Phone:318-636-4194
Mailing Address - Fax:318-636-4196
Practice Address - Street 1:90 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5926
Practice Address - Country:US
Practice Address - Phone:318-238-3197
Practice Address - Fax:318-238-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QM0855X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1885029Medicaid