Healthcare Provider Details

I. General information

NPI: 1932641669
Provider Name (Legal Business Name): THE FAMILY PRACTICE AT NORTHSHORE COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOLIDAY BLVD SUITE 120
COVINGTON LA
70433-5088
US

IV. Provider business mailing address

201 HOLIDAY BLVD SUITE 120
COVINGTON LA
70433-5088
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-2942
  • Fax: 985-231-1373
Mailing address:
  • Phone: 985-624-2942
  • Fax: 985-231-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDRE JUDICE
Title or Position: OWNER
Credential: PH.D.
Phone: 985-624-2942