Healthcare Provider Details

I. General information

NPI: 1306494760
Provider Name (Legal Business Name): OPTIMAL COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SUNSET AVE
HOUMA LA
70360-6653
US

IV. Provider business mailing address

157 NATALIE PARK DR
THIBODAUX LA
70301-8439
US

V. Phone/Fax

Practice location:
  • Phone: 985-360-8199
  • Fax:
Mailing address:
  • Phone: 985-360-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KE'ARRAH JACKSON
Title or Position: OWNER
Credential: LPC
Phone: 985-360-8199