=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962758367
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NETA COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2012
-----------------------------------------------------
Last Update Date | 08/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1203 BARROW ST
-----------------------------------------------------
City | HOUMA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70360-6303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-452-7002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5500 PRYTANIA ST #436
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70115-4237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-453-9949
-----------------------------------------------------
Fax | 775-213-9705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. AMANDA ATEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-453-9949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4563
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------