=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962742833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ECLECTIC COUNSELING SERVICES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2013
-----------------------------------------------------
Last Update Date | 02/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6305 ELYSIAN FIELDS AVE. 301 - A
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-281-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 0954
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-281-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | ROMONICA JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-281-7735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 008595279
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------