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General NPI Number Information
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NPI Number | 1427415918
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Entity Type | Organization
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Legal Business Name | FAMILY THERAPY AND WELLNESS CONSULTING
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 418 WEBB CT
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City | MINDEN
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State | LA
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Zip | 71055-2649
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Country | US
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Telephone | 318-371-2714
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Fax |
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Provider Business Mailing Address
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Address Line | 418 WEBB CT
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City | MINDEN
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State | LA
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Zip | 71055-2649
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD GRANT MARTIN
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Credential | MA, LPC, LMFT
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Telephone | 318-469-9132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 2032
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 2032
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License Number State | LA
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