MEDICARE: GRANDIR COUNSELING AND RESTORATION 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1326880600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDIR COUNSELING AND RESTORATION LLC

Provider Business Mailing Address
First Line	:	1114 ELI CONNOR DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4800
Country	:	US
Telephone Number	:	318-465-5184
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 CHINABERRY DR STE 502
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2462
Country	:	US
Telephone Number	:	318-465-5184
Fax Number	:

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	TIFFANY VOINCHE
Credential	:
Telephone Number	:	318-465-5184

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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