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General NPI Number Information
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NPI Number | 1992666184
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Entity Type | Organization
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Legal Business Name | MINDWELL THERAPY LLC
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 28552 SHADY DAY DR
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City | PONCHATOULA
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State | LA
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Zip | 70454-2851
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Country | US
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Telephone | 833-221-4169
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Fax |
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Provider Business Mailing Address
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Address Line | 28552 SHADY DAY DR
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City | PONCHATOULA
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State | LA
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Zip | 70454-2851
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER LORASO
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Credential |
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Telephone | 833-221-4169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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