Healthcare Provider Details

I. General information

NPI: 1699024448
Provider Name (Legal Business Name): FOREVER AND A DAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 31ST ST STE 2
MONROE LA
71201-3947
US

IV. Provider business mailing address

801 N 31ST ST STE 2
MONROE LA
71201-3947
US

V. Phone/Fax

Practice location:
  • Phone: 318-855-3868
  • Fax: 318-537-9688
Mailing address:
  • Phone: 318-855-3868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPPLIED FOR
License Number StateLA

VIII. Authorized Official

Name: MR. DUSTIN EBANKS
Title or Position: OWNER
Credential: OWNER
Phone: 504-256-3478