Healthcare Provider Details

I. General information

NPI: 1144166653
Provider Name (Legal Business Name): CENTER FOR COUNSELING AND PSYCHOLOGICAL RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BURGESSVILLE RD
RUSTON LA
71270-5154
US

IV. Provider business mailing address

622 BURGESSVILLE RD
RUSTON LA
71270-5154
US

V. Phone/Fax

Practice location:
  • Phone: 318-224-7223
  • Fax: 318-415-1004
Mailing address:
  • Phone: 318-224-7223
  • Fax: 318-415-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JILL SHANNON WALTEMATE
Title or Position: OWNER
Credential:
Phone: 318-675-9775