Healthcare Provider Details

I. General information

NPI: 1104881564
Provider Name (Legal Business Name): ACTIVE INTERVENTION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 STUMPF BLVD BLDG. 7 STE. 10
TERRYTOWN LA
70056-3950
US

IV. Provider business mailing address

1799 STUMPF BLVD BLDG. 7 STE. 10
TERRYTOWN LA
70056-3950
US

V. Phone/Fax

Practice location:
  • Phone: 504-367-5766
  • Fax: 504-367-5755
Mailing address:
  • Phone: 504-367-5766
  • Fax: 504-367-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2002
License Number StateLA

VIII. Authorized Official

Name: DR. MARILYN MCCLELLAND THORPE
Title or Position: COUNSELOR
Credential: PH.D.
Phone: 504-367-5766