MEDICARE: ARISE THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1053131888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARISE THERAPY LLC

Provider Business Mailing Address
First Line	:	217 ALTA MIRA DR
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-9798
Country	:	US
Telephone Number	:	318-680-0375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N 7TH ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-4334
Country	:	US
Telephone Number	:	318-680-0375
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	CHRISTIAN NICOLE GULLETTE
Credential	:	RAC
Telephone Number	:	318-680-0375

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	05/02/2025

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