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General NPI Number Information
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NPI Number | 1306494760
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Entity Type | Organization
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Legal Business Name | OPTIMAL COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 501 SUNSET AVE
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City | HOUMA
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State | LA
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Zip | 70360-6653
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Country | US
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Telephone | 985-360-8199
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Fax |
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Provider Business Mailing Address
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Address Line | 157 NATALIE PARK DR
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City | THIBODAUX
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State | LA
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Zip | 70301-8439
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Country | US
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Telephone | 985-360-8199
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KE'ARRAH JACKSON
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Credential | LPC
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Telephone | 985-360-8199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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