MEDICARE: COMPASSION AND GRACE COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1437080108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSION AND GRACE COUNSELING LLC

Provider Business Mailing Address
First Line	:	2285 BENTON RD STE D201E
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7933
Country	:	US
Telephone Number	:	318-524-8399
Fax Number	:	318-524-8399

Provider Business Practice Location Address
First Line	:	2285 BENTON RD STE D201E
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7933
Country	:	US
Telephone Number	:	318-524-8399
Fax Number	:	318-524-8399

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	MS. JONETTE PERETIK
Credential	:	LPC
Telephone Number	:	318-524-8399

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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