Provider Demographics
NPI:1598239550
Name:HEAL YOUR LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:HEAL YOUR LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:225-226-5947
Mailing Address - Street 1:18330 DOC OLENA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-0701
Mailing Address - Country:US
Mailing Address - Phone:225-226-5947
Mailing Address - Fax:
Practice Address - Street 1:8738 QUARTERS LAKE RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2194
Practice Address - Country:US
Practice Address - Phone:225-226-5947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty