Healthcare Provider Details

I. General information

NPI: 1689052284
Provider Name (Legal Business Name): SERENITY OUTREACH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N BROAD ST STE A
NEW ORLEANS LA
70119-5506
US

IV. Provider business mailing address

134 N BROAD ST STE A
NEW ORLEANS LA
70119-5506
US

V. Phone/Fax

Practice location:
  • Phone: 985-772-4138
  • Fax: 504-910-3065
Mailing address:
  • Phone: 985-772-4138
  • Fax: 504-910-3065

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 Number
License Number StateNULL

VIII. Authorized Official

Name: DAINA ALLEN
Title or Position: CEO
Credential:
Phone: 985-772-4138