Healthcare Provider Details

I. General information

NPI: 1659341915
Provider Name (Legal Business Name): COUNSELING ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTMARK BLVD SUITE A
LAFAYETTE LA
70506-7378
US

IV. Provider business mailing address

100 WESTMARK BLVD SUITE A
LAFAYETTE LA
70506-7378
US

V. Phone/Fax

Practice location:
  • Phone: 970-261-5498
  • Fax: 970-245-3216
Mailing address:
  • Phone: 970-261-5498
  • Fax: 970-245-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1158
License Number StateLA

VIII. Authorized Official

Name: MR. WILLIAM GLENN BORDELON
Title or Position: GEN PARTNER/OFFICER
Credential: MA, LMFT
Phone: 970-261-5498