Basic Information
| Provider Information | |||||||||
| NPI: | 1528504008 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABUNDANT COUNSELING SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ABUNDANT COUNSELING SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2439 MANHATTAN BLVD SUITE 207 | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043648949 | ||||||||
| FaxNumber: | 5045339735 | ||||||||
| Practice Location | |||||||||
| Address1: | 2439 MANHATTAN BLVD SUITE 207 | ||||||||
| Address2: | |||||||||
| City: | HARVEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043648949 | ||||||||
| FaxNumber: | 5043648968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2017 | ||||||||
| LastUpdateDate: | 02/13/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BOYD | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MHS | ||||||||
| AuthorizedOfficialTelephone: | 5043648949 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MASTERS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.