Provider Demographics
NPI:1154629277
Name:WINTERHAVEN PROFESSIONAL COUNSELING
Entity Type:Organization
Organization Name:WINTERHAVEN PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-228-8801
Mailing Address - Street 1:PO BOX 2221
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-2221
Mailing Address - Country:US
Mailing Address - Phone:318-228-8801
Mailing Address - Fax:318-228-8803
Practice Address - Street 1:1760 TEXAS ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-3429
Practice Address - Country:US
Practice Address - Phone:318-238-8801
Practice Address - Fax:318-238-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
LA5785118-001261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)