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General NPI Number Information
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NPI Number | 1073205373
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ALLIANCE NOLA LLC
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 3128 BORE ST
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City | METAIRIE
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State | LA
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Zip | 70001-5334
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Country | US
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Telephone | 504-261-4753
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Fax |
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Provider Business Mailing Address
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Address Line | 3128 BORE ST
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City | METAIRIE
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State | LA
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Zip | 70001-5334
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Country | US
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Telephone | 504-261-4753
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MICHAEL JOHN RUIZ
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Credential | LPC, LMFT
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Telephone | 504-261-4753
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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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