Healthcare Provider Details

I. General information

NPI: 1932504842
Provider Name (Legal Business Name): RESURRECTION & NEW LIFE FELLOWSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7569 E INDUSTRIAL DR
BATON ROUGE LA
70805-7518
US

IV. Provider business mailing address

PO BOX 45698
BATON ROUGE LA
70895-4698
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-9164
  • Fax: 225-924-5479
Mailing address:
  • Phone: 225-924-9164
  • Fax: 225-924-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD DARNELL TENNART
Title or Position: CLINICAL COORDINATOR/SR. PASTOR
Credential: PHD, DMIN, LPC, BCC,
Phone: 225-924-9164