Healthcare Provider Details

I. General information

NPI: 1437555042
Provider Name (Legal Business Name): LYN HASSENBOEHLER, LCSW COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12320 HIGHWAY 44 BLDG 3D
GONZALES LA
70737-2202
US

IV. Provider business mailing address

12320 HIGHWAY 44 BLDG 3D
GONZALES LA
70737-2202
US

V. Phone/Fax

Practice location:
  • Phone: 225-456-0093
  • Fax: 888-494-0963
Mailing address:
  • Phone: 225-456-0093
  • Fax: 888-494-0963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3340
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3340
License Number StateLA

VIII. Authorized Official

Name: MS. LYN HASSENBOEHLER
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 225-456-0093