Provider Demographics
NPI:1659763738
Name:THE MINISTRY OF RECONCILIATION, INC
Entity Type:Organization
Organization Name:THE MINISTRY OF RECONCILIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LPC
Authorized Official - Phone:985-312-2525
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-0344
Mailing Address - Country:US
Mailing Address - Phone:985-312-2525
Mailing Address - Fax:337-202-4042
Practice Address - Street 1:735 WEST DR
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-3410
Practice Address - Country:US
Practice Address - Phone:985-312-2525
Practice Address - Fax:337-202-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC #4906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11855485OtherCAQH
LA600887225Medicaid