Provider Demographics
NPI:1265327415
Name:ARK-LA-TEX MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:ARK-LA-TEX MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-416-9649
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-0837
Mailing Address - Country:US
Mailing Address - Phone:903-487-2248
Mailing Address - Fax:903-487-2306
Practice Address - Street 1:8660 FERN AVE STE 120
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5657
Practice Address - Country:US
Practice Address - Phone:318-416-9649
Practice Address - Fax:318-416-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty