Healthcare Provider Details

I. General information

NPI: 1487301438
Provider Name (Legal Business Name): MOVING FORWARD COUNSELING CENTER OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E. ASCENSION STREET SUITE PMB260
GONZALES LA
70737
US

IV. Provider business mailing address

PO BOX 1970
PRAIRIEVILLE LA
70769-1970
US

V. Phone/Fax

Practice location:
  • Phone: 225-279-4145
  • Fax:
Mailing address:
  • Phone: 225-279-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ASHLEY SNOWDEN
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 225-279-4145