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General NPI Number Information
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NPI Number | 1013451830
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Entity Type | Individual
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Provider Name | BOBBY CHURCH LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 107 MILLER ST
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City | FARMERVILLE
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State | LA
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Zip | 71241-2311
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Country | US
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Telephone | 318-368-4755
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Fax | 318-982-8050
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Provider Business Mailing Address
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Address Line | 107 MILLER STREET
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City | FARMERVILLE
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State | LA
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Zip | 71241-2311
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Country | US
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Telephone | 318-368-4755
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Fax | 318-982-8050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LPC#4604
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License Number State | LA
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