1316276231 NPI number — BALM IN GILEAD BIG CHRISTIAN COUNSELING SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316276231 NPI number — BALM IN GILEAD BIG CHRISTIAN COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALM IN GILEAD BIG CHRISTIAN COUNSELING SERVICES LLC
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:
1316276231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 MURRAY ST
Provider Second Line Business Mailing Address:
STE 224
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71301-6890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-286-4672
Provider Business Mailing Address Fax Number:
866-391-2080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 MURRAY ST
Provider Second Line Business Practice Location Address:
STE 224
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-6890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-286-4672
Provider Business Practice Location Address Fax Number:
866-391-2080
Provider Enumeration Date:
12/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BELCHER
Authorized Official First Name:
SONYA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
318-286-4672

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1807770 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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