Provider Demographics
NPI:1497347090
Name:LIFE JOURNEY WELLNESS OF LOUISIANA
Entity Type:Organization
Organization Name:LIFE JOURNEY WELLNESS OF LOUISIANA
Other - Org Name:LIFE JOURNEY WELLNESS OF LOUISIANA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOYETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-707-2080
Mailing Address - Street 1:1000 CHINABERRY DR STE 1001
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2463
Mailing Address - Country:US
Mailing Address - Phone:318-707-2080
Mailing Address - Fax:318-532-4910
Practice Address - Street 1:1000 CHINABERRY DR STE 1001
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2463
Practice Address - Country:US
Practice Address - Phone:318-707-2080
Practice Address - Fax:318-532-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487273348OtherNPPES