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General NPI Number Information
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NPI Number | 1710632419
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Entity Type | Organization
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Legal Business Name | BIG EASY THERAPY
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 1799 STUMPF BLVD BUILDING 2, SUITE 5
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City | TERRYTOWN
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State | LA
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Zip | 70056
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Country | US
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Telephone | 504-233-2295
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Fax | 504-910-0651
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Provider Business Mailing Address
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Address Line | 1799 STUMPF BLVD BUILDING 2, SUITE 5
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City | TERRYTOWN
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State | LA
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Zip | 70056
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Country | US
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Telephone | 504-233-2295
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Fax | 504-910-0651
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | NIKOLE L DOMINIQUE-MAIKELL
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Credential | MS LMFT
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Telephone | 504-233-2295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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