Healthcare Provider Details

I. General information

NPI: 1457282683
Provider Name (Legal Business Name): MANNA HORSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 CAMP ZION RD
HAUGHTON LA
71037-9166
US

IV. Provider business mailing address

PO BOX 233
HAUGHTON LA
71037
US

V. Phone/Fax

Practice location:
  • Phone: 318-610-7599
  • Fax: 318-252-2394
Mailing address:
  • Phone: 318-455-0243
  • Fax: 318-252-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA CRUSE
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 318-455-0243