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NPI Code Detail

MEDICARE: BODY & SOUL SERVICES, INC.

MEDICARE: BODY & SOUL SERVICES, INC.
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
1101YM0800XMental Health Counselor
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1285193185
Entity Type Code : Organization
Provider Name (Legal Business Name) : BODY & SOUL SERVICES, INC.
Provider Business Mailing Address
First Line : 5743 MER ROUGE RD
Second Line :
City : BASTROP
State : LA
Zip : 71220-9765
Country : US
Telephone Number : 318-974-6035
Fax Number : 318-515-0019
Provider Business Practice Location Address
First Line : 5743 MER ROUGE RD
Second Line :
City : BASTROP
State : LA
Zip : 71220-9765
Country : US
Telephone Number : 318-283-3299
Fax Number : 318-283-3298
Authorized Official
Title or Position : CFO, VP
Name : DERENDA FLOWERS
Credential :
Telephone Number : 318-283-3299
Provider Enumeration Date : 03/19/2019
Last Update Date : 06/27/2024

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Directions to “BODY & SOUL SERVICES, INC. ” Practice Location

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