Healthcare Provider Details

I. General information

NPI: 1932016417
Provider Name (Legal Business Name): EMERGE THERAPY & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2761 E MILTON AVE STE D1
YOUNGSVILLE LA
70592-6702
US

IV. Provider business mailing address

104 MAEBETH LN
YOUNGSVILLE LA
70592-6798
US

V. Phone/Fax

Practice location:
  • Phone: 985-852-0306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JACEY LOPEZ
Title or Position: OWNER/CLINICIAN
Credential:
Phone: 985-852-0306