Provider Demographics
NPI:1922634955
Name:DESIREE EARLE COUNSELING AND CONSULTATION
Entity Type:Organization
Organization Name:DESIREE EARLE COUNSELING AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:318-453-6897
Mailing Address - Street 1:326 LEVIN LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4714
Mailing Address - Country:US
Mailing Address - Phone:318-453-6897
Mailing Address - Fax:
Practice Address - Street 1:1613 JIMMIE DAVIS HWY STE 400
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4557
Practice Address - Country:US
Practice Address - Phone:318-584-7297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)