Provider Demographics
NPI:1083625230
Name:THE FAMILY TREE INFORMATION, EDUCATION AND COUNSELING CENTER
Entity Type:Organization
Organization Name:THE FAMILY TREE INFORMATION, EDUCATION AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT, LAC
Authorized Official - Phone:337-981-2180
Mailing Address - Street 1:1602 W PINHOOK RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3745
Mailing Address - Country:US
Mailing Address - Phone:337-981-2180
Mailing Address - Fax:337-819-2391
Practice Address - Street 1:1602 W PINHOOK RD STE 100A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3745
Practice Address - Country:US
Practice Address - Phone:337-981-2180
Practice Address - Fax:337-819-2391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty