Basic Information
| Provider Information | |||||||||
| NPI: | 1619015302 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFE SOLUTIONS INC OF ALEX | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5501 JOHN ESKEW BLVD | ||||||||
| Address2: | C | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184498571 | ||||||||
| FaxNumber: | 3184498506 | ||||||||
| Practice Location | |||||||||
| Address1: | 5501 JOHN ESKEW BLVD | ||||||||
| Address2: | C | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184498571 | ||||||||
| FaxNumber: | 3184498506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GIRARD | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT LIFE SOLUTIONS | ||||||||
| AuthorizedOfficialTelephone: | 3184498571 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC LMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LA | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 106H00000X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.