1215447859 NPI number — INSTAR COUNSELING OF THE NORTHSHORE

Table of content: (NPI 1215447859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215447859 NPI number — INSTAR COUNSELING OF THE NORTHSHORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTAR COUNSELING OF THE NORTHSHORE
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:
1215447859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 COLONIAL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70471-8910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-705-2765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22532 HIGHWAY 1088
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70448-8450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-705-7736
Provider Business Practice Location Address Fax Number:
985-234-9844
Provider Enumeration Date:
10/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HOWELL
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
MISTICH
Authorized Official Title or Position:
OWNER/LPC
Authorized Official Telephone Number:
985-705-2765

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  4560 , 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)

  • Identifier: 1912248808 . This is a "NPI" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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