Provider Demographics
NPI:1710632419
Name:BIG EASY THERAPY
Entity Type:Organization
Organization Name:BIG EASY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOMINIQUE-MAIKELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT
Authorized Official - Phone:504-233-2295
Mailing Address - Street 1:1799 STUMPF BLVD
Mailing Address - Street 2:BUILDING 2, SUITE 5
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-233-2295
Mailing Address - Fax:504-910-0651
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:BUILDING 2, SUITE 5
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-233-2295
Practice Address - Fax:504-910-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty