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General NPI Number Information
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NPI Number | 1669928453
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Entity Type | Organization
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Legal Business Name | PHOENIX COUNSELING AND THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 1720 STUMPF BLVD 202
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City | TERRYTOWN
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State | LA
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Zip | 70056-3997
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Country | US
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Telephone | 504-382-9879
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Fax | 504-910-9339
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Provider Business Mailing Address
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Address Line | 1221 L B LANDRY AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70114-2656
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Country | US
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Telephone | 504-382-9879
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Fax | 504-910-9339
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Authorized Official
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Title or Position | OWNER
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Name | MRS. YETTIA BENN JASMINE
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Credential | LCSW
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Telephone | 504-382-9879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6795
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License Number State | LA
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