Healthcare Provider Details

I. General information

NPI: 1083625230
Provider Name (Legal Business Name): THE FAMILY TREE INFORMATION, EDUCATION AND COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W PINHOOK RD STE 100A
LAFAYETTE LA
70508-3745
US

IV. Provider business mailing address

1602 W PINHOOK RD STE 100A
LAFAYETTE LA
70508-3745
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-2180
  • Fax: 337-819-2391
Mailing address:
  • Phone: 337-981-2180
  • Fax: 337-819-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4075
License Number StateLA

VIII. Authorized Official

Name: MRS. MARIE COLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC, LMFT, LAC
Phone: 337-981-2180