Basic Information
| Provider Information | |||||||||
| NPI: | 1043834104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LYFE COUNSELING CONSULTATION & TRAINING | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LYFE COUNSELING CONSULTATION & TRAINING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40466 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708350466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259369383 | ||||||||
| FaxNumber: | 2256628772 | ||||||||
| Practice Location | |||||||||
| Address1: | 33847 NICOLE LN | ||||||||
| Address2: | |||||||||
| City: | DENHAM SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707062048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259369383 | ||||||||
| FaxNumber: | 2256648772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2020 | ||||||||
| LastUpdateDate: | 10/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | TOUSSAINT | ||||||||
| AuthorizedOfficialFirstName: | ANNETTE | ||||||||
| AuthorizedOfficialMiddleName: | SIAS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2259369383 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.