Healthcare Provider Details

I. General information

NPI: 1598382301
Provider Name (Legal Business Name): GRACISHONE LARRIAN FLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2742 AUGUSTA ST
KENNER LA
70062-5118
US

IV. Provider business mailing address

2742 AUGUSTA ST
KENNER LA
70062-5118
US

V. Phone/Fax

Practice location:
  • Phone: 504-333-9635
  • Fax:
Mailing address:
  • Phone: 504-333-9635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9316
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: