Provider Demographics
NPI:1013451830
Name:CHURCH, BOBBY (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:CHURCH
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MILLER STREET
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-2311
Mailing Address - Country:US
Mailing Address - Phone:318-368-4755
Mailing Address - Fax:318-982-8050
Practice Address - Street 1:107 MILLER ST
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-2311
Practice Address - Country:US
Practice Address - Phone:318-368-4755
Practice Address - Fax:318-982-8050
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC#4604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional