Healthcare Provider Details

I. General information

NPI: 1578263703
Provider Name (Legal Business Name): TRAUMA RECOVERY & COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8369 FLORIDA BLVD STE 3
DENHAM SPRINGS LA
70726-7862
US

IV. Provider business mailing address

18522 BELLINGRATH LAKES AVE
GREENWELL SPRINGS LA
70739-4766
US

V. Phone/Fax

Practice location:
  • Phone: 225-242-9865
  • Fax:
Mailing address:
  • Phone: 225-242-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEE RILES-STEWART
Title or Position: PSYCHOTHERAPIST
Credential: LPC
Phone: 225-242-9865