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General NPI Number Information
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NPI Number | 1811243504
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Entity Type | Organization
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Legal Business Name | CRISIS 504 LLC
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 3528 VINCENNES PLACE
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City | NEW ORLEANS
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State | LA
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Zip | 70125
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Country | US
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Telephone | 504-908-5799
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Fax |
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Provider Business Mailing Address
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Address Line | 3528 VINCENNES PLACE
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City | NEW ORLEANS
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State | LA
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Zip | 70125
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Country | US
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Telephone | 504-908-5799
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CECILE WATTERS TEBO
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Credential | LCSW
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Telephone | 504-908-5799
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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 | 2415
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License Number State | LA
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