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General NPI Number Information
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NPI Number | 1255760088
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Entity Type | Organization
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Legal Business Name | MAISON VIE, LLC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 1799 STUMPF BLVD 3-2
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City | TERRYTOWN
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State | LA
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Zip | 70056-3950
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Country | US
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Telephone | 504-452-5937
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Fax | 504-394-5012
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Provider Business Mailing Address
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Address Line | 1799 STUMPF BLVD 3-2
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City | TERRYTOWN
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State | LA
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Zip | 70056-3950
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Country | US
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Telephone | 504-452-5937
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Fax | 504-394-5012
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Authorized Official
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Title or Position | FAMILY THERAPIST
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Name | MS. SUSAN GAYLE HARRINGTON
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Credential | LPC-S, LMFT-S, NCC
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Telephone | 504-452-5937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2328
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License Number State | LA
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