Provider Demographics
NPI:1639567290
Name:THE EQUESTRIAN THERAPY CENTER OF SLIDELL
Entity Type:Organization
Organization Name:THE EQUESTRIAN THERAPY CENTER OF SLIDELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:985-641-4934
Mailing Address - Street 1:32597 C C RD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-3269
Mailing Address - Country:US
Mailing Address - Phone:985-641-4934
Mailing Address - Fax:985-649-0982
Practice Address - Street 1:32597 C C RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-3269
Practice Address - Country:US
Practice Address - Phone:985-641-4934
Practice Address - Fax:985-649-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty