Provider Demographics
NPI:1871139501
Name:NORRED, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NORRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9882 MOORINGSPORT LATEX RD
Mailing Address - Street 2:
Mailing Address - City:MOORINGSPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71060-8507
Mailing Address - Country:US
Mailing Address - Phone:318-210-7194
Mailing Address - Fax:
Practice Address - Street 1:3003 KNIGHT ST STE 115
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2561
Practice Address - Country:US
Practice Address - Phone:318-227-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist