Healthcare Provider Details

I. General information

NPI: 1487156402
Provider Name (Legal Business Name): ELOISE KAYOLINE COLLINS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SECURITY BLVD STE F
HOUMA LA
70360-2780
US

IV. Provider business mailing address

116 CENTRAL AVE
HOUMA LA
70364-3008
US

V. Phone/Fax

Practice location:
  • Phone: 985-796-2170
  • Fax:
Mailing address:
  • Phone: 985-860-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7311
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: