Provider Demographics
NPI:1548906381
Name:HEADSPACE COUNSELING & RECOVERY LLC
Entity type:Organization
Organization Name:HEADSPACE COUNSELING & RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LAC
Authorized Official - Phone:337-349-1218
Mailing Address - Street 1:302 ANSLEM DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5380
Mailing Address - Country:US
Mailing Address - Phone:337-349-1218
Mailing Address - Fax:
Practice Address - Street 1:113 FLAGG PL STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7025
Practice Address - Country:US
Practice Address - Phone:337-349-1218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty