MEDICARE: HEADSPACE COUNSELING & RECOVERY 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	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1548906381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEADSPACE COUNSELING & RECOVERY LLC

Provider Business Mailing Address
First Line	:	302 ANSLEM DR
Second Line	:
City	:	YOUNGSVILLE
State	:	LA
Zip	:	70592-5380
Country	:	US
Telephone Number	:	337-349-1218
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 FLAGG PL STE B
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-7025
Country	:	US
Telephone Number	:	337-349-1218
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LINDSEY A GUILLORY
Credential	:	LPC LAC
Telephone Number	:	337-349-1218

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	09/30/2024

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