Healthcare Provider Details

I. General information

NPI: 1104270693
Provider Name (Legal Business Name): BREATH OF LIFE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71667 LEVESON ST
ABITA SPRINGS LA
70420-3635
US

IV. Provider business mailing address

71667 LEVESON ST
ABITA SPRINGS LA
70420-3635
US

V. Phone/Fax

Practice location:
  • Phone: 985-264-8089
  • Fax:
Mailing address:
  • Phone: 985-264-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3035
License Number StateLA

VIII. Authorized Official

Name: PATRICIA J STOUT
Title or Position: OWNER
Credential: LCSW
Phone: 985-264-8089