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General NPI Number Information
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NPI Number | 1003798901
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Entity Type | Organization
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Legal Business Name | MIND REWIRED PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 105 NW RAILROAD AVE UNIT 193
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City | HAMMOND
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State | LA
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Zip | 70404-5008
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Country | US
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Telephone | 985-361-9570
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Fax | 985-202-8433
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Provider Business Mailing Address
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Address Line | PO BOX 193
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City | HAMMOND
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State | LA
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Zip | 70404-0193
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Country | US
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Telephone | 985-361-9570
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Fax | 985-202-8433
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | VASILIKI LABONTE
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Credential | MS, LPC
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Telephone | 985-361-9570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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