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General NPI Number Information
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NPI Number | 1558697672
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Entity Type | Organization
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Legal Business Name | FAMILIES FOR LIFE, LLC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 201 PAUL MAILLARD RD
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City | LULING
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State | LA
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Zip | 70070-4203
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Country | US
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Telephone | 504-650-9575
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Fax |
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Provider Business Mailing Address
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Address Line | 201 PAUL MAILLARD RD
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City | LULING
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State | LA
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Zip | 70070-4203
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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 | CO-OWNER
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Name | MS. NICOLE MCMYNE
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Credential | LPC, NCC
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Telephone | 504-650-9575
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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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