Healthcare Provider Details

I. General information

NPI: 1396269932
Provider Name (Legal Business Name): SPRINGHILL FAMILY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26597 HWY 371
SAREPTA LA
71071
US

IV. Provider business mailing address

1205 BAKER ST
SPRINGHILL LA
71075-3609
US

V. Phone/Fax

Practice location:
  • Phone: 318-578-0069
  • Fax: 318-994-2240
Mailing address:
  • Phone: 318-578-0069
  • Fax: 318-994-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3806
License Number StateLA

VIII. Authorized Official

Name: MS. RITA MCCLURE COOK
Title or Position: PROVIDER
Credential:
Phone: 318-578-0069