Provider Demographics
NPI:1871793935
Name:QUALLS, MONA MURIEL (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:MONA
Middle Name:MURIEL
Last Name:QUALLS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 HIGHLAND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4143
Mailing Address - Country:US
Mailing Address - Phone:318-364-7054
Mailing Address - Fax:318-742-0763
Practice Address - Street 1:1002 HIGHLAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4143
Practice Address - Country:US
Practice Address - Phone:318-364-7054
Practice Address - Fax:318-742-0763
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3513101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional