Provider Demographics
NPI:1821758749
Name:ROOTS COUNSELING LLC
Entity Type:Organization
Organization Name:ROOTS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONSOULIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-502-9497
Mailing Address - Street 1:1510 HODGES ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-6013
Mailing Address - Country:US
Mailing Address - Phone:337-502-9497
Mailing Address - Fax:337-340-9305
Practice Address - Street 1:1510 HODGES ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6013
Practice Address - Country:US
Practice Address - Phone:337-502-9497
Practice Address - Fax:337-340-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty