Healthcare Provider Details

I. General information

NPI: 1699609404
Provider Name (Legal Business Name): PURE THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 KNIGHT LN STE 4
LAKE CHARLES LA
70605-1206
US

IV. Provider business mailing address

301 E PARK MANOR DR
LAKE CHARLES LA
70611-3920
US

V. Phone/Fax

Practice location:
  • Phone: 337-302-1117
  • Fax:
Mailing address:
  • Phone: 337-302-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. RYAN CLEMONS
Title or Position: COUNSELOR
Credential: LPC
Phone: 337-302-1117