Healthcare Provider Details

I. General information

NPI: 1255791950
Provider Name (Legal Business Name): GWANGIS CONSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 TURTLE CREEK LN
SAINT ROSE LA
70087-3824
US

IV. Provider business mailing address

308 TURTLE CREEK LN
SAINT ROSE LA
70087-3824
US

V. Phone/Fax

Practice location:
  • Phone: 985-287-2187
  • Fax:
Mailing address:
  • Phone: 985-287-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: KENYA JOSEPH
Title or Position: MHS
Credential:
Phone: 985-287-2187