Healthcare Provider Details

I. General information

NPI: 1366824641
Provider Name (Legal Business Name): MILESTONES COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2836 FRONT ST
SLIDELL LA
70458-4334
US

IV. Provider business mailing address

2408 ROBIN ST
SLIDELL LA
70460-6644
US

V. Phone/Fax

Practice location:
  • Phone: 985-503-5949
  • Fax:
Mailing address:
  • Phone: 985-503-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4931
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number4931
License Number StateLA

VIII. Authorized Official

Name: MS. LISA MARIE BERKMAN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: M.ED., LPC, NCC
Phone: 985-503-5949