Healthcare Provider Details

I. General information

NPI: 1376158154
Provider Name (Legal Business Name): TOTAL LIFE CARES HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 BLUEBONNET BLVD STE D
BATON ROUGE LA
70809-9647
US

IV. Provider business mailing address

4451 BLUEBONNET BLVD STE D
BATON ROUGE LA
70809-9647
US

V. Phone/Fax

Practice location:
  • Phone: 225-590-3313
  • Fax: 225-590-3324
Mailing address:
  • Phone: 225-590-3313
  • Fax: 225-590-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAYNNA GILBERT
Title or Position: CHIEF EXECUTIVE OFFICER (CEO)
Credential: PLPC
Phone: 225-590-3313