Basic Information
| Provider Information | |||||||||
| NPI: | 1497113559 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHEAST COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 343 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712203849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189745075 | ||||||||
| FaxNumber: | 8442701958 | ||||||||
| Practice Location | |||||||||
| Address1: | 343 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712203849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189745075 | ||||||||
| FaxNumber: | 8442701958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2016 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | KEY | ||||||||
| AuthorizedOfficialFirstName: | TERRANCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3186807792 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.