Provider Demographics
NPI:1144575531
Name:MOSS SIDE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:MOSS SIDE COUNSELING SERVICES, LLC
Other - Org Name:MOSS SIDE COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CRC, LPP
Authorized Official - Phone:225-324-8075
Mailing Address - Street 1:5700 FLORIDA BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4274
Mailing Address - Country:US
Mailing Address - Phone:225-448-5567
Mailing Address - Fax:225-448-5901
Practice Address - Street 1:5700 FLORIDA BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4274
Practice Address - Country:US
Practice Address - Phone:225-448-5567
Practice Address - Fax:225-448-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00016582251B00000X
LA1079252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management