Healthcare Provider Details

I. General information

NPI: 1831854868
Provider Name (Legal Business Name): THERAPEUTIC SOLUTIONS OF CENTRAL LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 JACKSON ST STE B
ALEXANDRIA LA
71303-2595
US

IV. Provider business mailing address

405 SKYBLUE DR
PINEVILLE LA
71360-9002
US

V. Phone/Fax

Practice location:
  • Phone: 318-265-7134
  • Fax:
Mailing address:
  • Phone: 318-485-9149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH SIMON-CLARK
Title or Position: OWNER
Credential:
Phone: 318-485-9149