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General NPI Number Information
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NPI Number | 1144575531
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Entity Type | Organization
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Legal Business Name | MOSS SIDE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 5700 FLORIDA BLVD SUITE 312
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City | BATON ROUGE
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State | LA
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Zip | 70806-4274
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Country | US
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Telephone | 225-448-5567
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Fax | 225-448-5901
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Provider Business Mailing Address
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Address Line | 5700 FLORIDA BLVD SUITE 312
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City | BATON ROUGE
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State | LA
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Zip | 70806-4274
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Country | US
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Telephone | 225-448-5567
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Fax | 225-448-5901
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBORAH LYNETTE THOMAS
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Credential | PH.D., CRC, LPP
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Telephone | 225-324-8075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 00016582
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1079
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License Number State | LA
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