Healthcare Provider Details

I. General information

NPI: 1407748312
Provider Name (Legal Business Name): MACKENZIE ELEANOR MCCOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 RIVER RD
LULING LA
70070-4165
US

IV. Provider business mailing address

13101 RIVER RD
LULING LA
70070-4165
US

V. Phone/Fax

Practice location:
  • Phone: 985-331-1999
  • Fax:
Mailing address:
  • Phone: 985-331-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10228
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: