MEDICARE: REAL TALK THERAPEUTIC SERVICES 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1588324693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REAL TALK THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	3350 RIDGELAKE DR STE 200
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-3831
Country	:	US
Telephone Number	:	504-434-0017
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 RIDGELAKE DR STE 200
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-3831
Country	:	US
Telephone Number	:	504-434-0017
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CLINICAL SOCIAL WORKER
Name	:	MRS. JILLANA VESSEL-THOMPSON
Credential	:	LCSW
Telephone Number	:	504-434-0017

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	12/30/2021

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