Provider Demographics
NPI:1013363654
Name:SOURCE OF SOLUTIONS COUNSELING SERVICE, LLC
Entity Type:Organization
Organization Name:SOURCE OF SOLUTIONS COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-584-7197
Mailing Address - Street 1:2285 BENTON RD STE D103
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3465
Mailing Address - Country:US
Mailing Address - Phone:318-584-7197
Mailing Address - Fax:318-584-7080
Practice Address - Street 1:2285 BENTON RD STE D103
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3465
Practice Address - Country:US
Practice Address - Phone:318-584-7197
Practice Address - Fax:318-584-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health