Healthcare Provider Details

I. General information

NPI: 1962971101
Provider Name (Legal Business Name): REALISTIC RESULTS THERAPY AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 DICKORY AVE
RIVER RIDGE LA
70123-2297
US

IV. Provider business mailing address

1117 DICKORY AVE
RIVER RIDGE LA
70123-2297
US

V. Phone/Fax

Practice location:
  • Phone: 504-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LASHENA HAYNES
Title or Position: OWNER/MANAGER
Credential: LCSW
Phone: 504-758-9280