Healthcare Provider Details

I. General information

NPI: 1174281497
Provider Name (Legal Business Name): TIPPERARY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 GLOUSTER ST
GRETNA LA
70056-4432
US

IV. Provider business mailing address

2128 GLOUSTER ST
GRETNA LA
70056-4432
US

V. Phone/Fax

Practice location:
  • Phone: 504-432-5306
  • Fax:
Mailing address:
  • Phone: 504-432-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DESMOND OCONNOR
Title or Position: PROVIDER
Credential: LPC. LMFT
Phone: 504-432-5306