Healthcare Provider Details

I. General information

NPI: 1851104798
Provider Name (Legal Business Name): FLEUR DE LIS COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HOWARD ST STE R
SPOKANE WA
99201-0508
US

IV. Provider business mailing address

PO BOX 1
CRESTWOOD KY
40014-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-567-7177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HANNAH PAINE
Title or Position: COUNSELOR
Credential: LMHC, LPCC
Phone: 502-904-3193