MEDICARE: EMMANUEL COUNSELING SERVICES

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	295	LA

General Provider Information

NPI Number	:	1588960918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2409 2ND ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-0100
Country	:	US
Telephone Number	:	337-485-9564
Fax Number	:	337-905-0669

Provider Business Practice Location Address
First Line	:	2409 2ND ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-0100
Country	:	US
Telephone Number	:	337-485-9564
Fax Number	:	337-905-0669

Authorized Official
Title or Position	:	THERAPIST
Name	:	CATHERINE JANE LEROUX
Credential	:	LMFT, LPC
Telephone Number	:	337-485-9564

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	02/02/2011

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