Healthcare Provider Details

I. General information

NPI: 1982392262
Provider Name (Legal Business Name): SERENITY CHILD AND YOUTH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WEST DRIVE
DERIDDER LA
70634
US

IV. Provider business mailing address

PO BOX 92
ROSEPINE LA
70659-0092
US

V. Phone/Fax

Practice location:
  • Phone: 337-348-1133
  • Fax:
Mailing address:
  • Phone: 337-348-1133
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MADDOX
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 337-348-1133