Healthcare Provider Details

I. General information

NPI: 1326594789
Provider Name (Legal Business Name): ALLEGIANT RESOURCES & COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 GOVERNMENT ST SUITE 8
ALEXANDRIA LA
71302-3358
US

IV. Provider business mailing address

3717 GOVERNMENT ST SUITE 8
ALEXANDRIA LA
71302-3358
US

V. Phone/Fax

Practice location:
  • Phone: 318-704-6041
  • Fax: 318-704-6645
Mailing address:
  • Phone: 318-704-6041
  • Fax: 318-704-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5899
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5899
License Number StateLA

VIII. Authorized Official

Name: MRS. KALA JENKINS
Title or Position: MANAGER
Credential: LPC
Phone: 318-704-6041