MEDICARE: SAFE SPACES COUNSELING AND WELLNESS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	251S00000X	Community/Behavioral Health Agency
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1316608334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE SPACES COUNSELING AND WELLNESS

Provider Business Mailing Address
First Line	:	4310 BARKSDALE BLVD
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-3911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 WHITEFIELD LN
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4277
Country	:	US
Telephone Number	:	225-588-3097
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LENISE WASHINGTON
Credential	:	LPC-S
Telephone Number	:	225-588-3097

Provider Enumeration Date	:	01/02/2022
Last Update Date	:	01/02/2022

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