Provider Demographics
NPI:1902431307
Name:THE COUNSELING CENTER AT NORTHSHORE CHURCH
Entity Type:Organization
Organization Name:THE COUNSELING CENTER AT NORTHSHORE CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:AUTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-262-1220
Mailing Address - Street 1:310 KENSINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2248
Mailing Address - Country:US
Mailing Address - Phone:985-262-1220
Mailing Address - Fax:
Practice Address - Street 1:310 KENSINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2248
Practice Address - Country:US
Practice Address - Phone:985-262-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty