Provider Demographics
NPI:1104180884
Name:A LIFE CHOICE FOR PERSONAL ENHANCEMENT, LLC
Entity Type:Organization
Organization Name:A LIFE CHOICE FOR PERSONAL ENHANCEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARSHALL-FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:504-362-0504
Mailing Address - Street 1:401 WHITNEY AVE
Mailing Address - Street 2:604
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2558
Mailing Address - Country:US
Mailing Address - Phone:504-362-0504
Mailing Address - Fax:504-362-0504
Practice Address - Street 1:401 WHITNEY AVE
Practice Address - Street 2:604
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2558
Practice Address - Country:US
Practice Address - Phone:504-362-0504
Practice Address - Fax:504-362-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4671998251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA03OtherHUMANA
LA04OtherMHNET/BEHAVIORAL HEALTH
LA06OtherHMO OF LA
LA13OtherCOVENTRY HEALTH CARE
LA02OtherCOMPCARE
LA07OtherUNITED BEHAVIORAL HEALTH
LA08OtherVALUE OPTIONS INC
LA4000Medicaid
LA05OtherMHNET SPECIALTY SERVICES
LA10OtherAPWU HEALTH CARE
LA11OtherLIFESYNCH
LA001OtherBCBS OF LOUISIANA
LA0007792856OtherAETNA
LA09OtherMILITARY ONESOURCE
LA12OtherGEVERNMENT EMPLOYEES HEALTH ASSOCIATION INC.