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NPI Code Detail

MEDICARE: THERESA STINE LPC

MEDICARE: THERESA STINE LPC
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
1101YP2500XProfessional Counselor
2101YM0800XMental Health Counselor4234LA

General Provider Information

NPI Number : 1871918193
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA STINE LPC
Provider Business Mailing Address
First Line : 231 JEFFERSON HEIGHTS AVE
Second Line :
City : JEFFERSON
State : LA
Zip : 70121-3209
Country : US
Telephone Number : 504-813-4564
Fax Number :
Provider Business Practice Location Address
First Line : 6321 STRATFORD PL
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70131-7325
Country : US
Telephone Number : 504-252-9015
Fax Number : 504-252-9621
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2014
Last Update Date : 12/28/2020

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