1295097350 NPI number — CANAL STREET COUNSELING, L.L.C.

Table of content: (NPI 1295097350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295097350 NPI number — CANAL STREET COUNSELING, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANAL STREET COUNSELING, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295097350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6744
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70174-6744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-309-7844
Provider Business Mailing Address Fax Number:
504-309-7845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3701 CANAL ST
Provider Second Line Business Practice Location Address:
STE. D
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70119-6160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-484-0457
Provider Business Practice Location Address Fax Number:
504-484-5289
Provider Enumeration Date:
06/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HUTTON
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHIATRIST
Authorized Official Telephone Number:
504-484-0457

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MD.200204 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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