Provider Demographics
NPI:1194009993
Name:THERAPEUTIC COUNSELING CLINIC INC
Entity Type:Organization
Organization Name:THERAPEUTIC COUNSELING CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-735-9448
Mailing Address - Street 1:542 COLUMBIA ST STE B
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-4720
Mailing Address - Country:US
Mailing Address - Phone:985-735-9448
Mailing Address - Fax:985-735-8097
Practice Address - Street 1:542 COLUMBIA ST STE B
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4720
Practice Address - Country:US
Practice Address - Phone:985-735-9448
Practice Address - Fax:985-735-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2023-06-19
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1740379262OtherMEDICARE, CMHC