Provider Demographics
NPI:1730550104
Name:MCCALPHIN, FARIS (MHS)
Entity type:Individual
Prefix:
First Name:FARIS
Middle Name:
Last Name:MCCALPHIN
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:FARIS
Other - Middle Name:
Other - Last Name:SHINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHP
Mailing Address - Street 1:2015 FAIRFIELD AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2066
Mailing Address - Country:US
Mailing Address - Phone:318-344-3640
Mailing Address - Fax:
Practice Address - Street 1:8921 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2144
Practice Address - Country:US
Practice Address - Phone:318-626-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5500101YA0400X
171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator