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General NPI Number Information
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NPI Number | 1912281031
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Entity Type | Organization
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Legal Business Name | FAIRWAY COUNSELING AGENCY, INC.
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 710 VERSAILLES BLVD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2351
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Country | US
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Telephone | 318-449-4474
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Fax |
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Provider Business Mailing Address
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Address Line | 101 FEU FOLLET RD STE 100
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City | LAFAYETTE
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State | LA
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Zip | 70508-4234
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Country | US
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Telephone | 337-234-8455
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Fax | 318-449-4472
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Authorized Official
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Title or Position | SEASIDE HC BILLING SUPERVISOR
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Name | GEMMALYN PRYOR
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Credential |
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Telephone | 337-234-8280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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