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NPI Code Detail

MEDICARE: GRANBERRY COUNSELING CENTER

MEDICARE: GRANBERRY COUNSELING CENTER
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 Counselor4441LA

General Provider Information

NPI Number : 1508100801
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANBERRY COUNSELING CENTER
Provider Business Mailing Address
First Line : 7200 DESIARD ST
Second Line :
City : MONROE
State : LA
Zip : 71203-3913
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7200 DESIARD ST
Second Line :
City : MONROE
State : LA
Zip : 71203-3913
Country : US
Telephone Number : 318-345-8200
Fax Number : 318-342-8049
Authorized Official
Title or Position : DIRECTOR
Name : DR. KATHY EICHELBERGER
Credential :
Telephone Number : 318-345-8200
Provider Enumeration Date : 11/27/2012
Last Update Date : 11/27/2012

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Directions to “GRANBERRY COUNSELING CENTER ” Practice Location

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