Healthcare Provider Details

I. General information

NPI: 1548906381
Provider Name (Legal Business Name): HEADSPACE COUNSELING & RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 FLAGG PL STE B
LAFAYETTE LA
70508-7025
US

IV. Provider business mailing address

302 ANSLEM DR
YOUNGSVILLE LA
70592-5380
US

V. Phone/Fax

Practice location:
  • Phone: 337-349-1218
  • Fax:
Mailing address:
  • Phone: 337-349-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDSEY A GUILLORY
Title or Position: OWNER
Credential: LPC LAC
Phone: 337-349-1218