Provider Demographics
NPI:1336844430
Name:HUMBLE HEALING COGNITIVE SERVICES LLC
Entity Type:Organization
Organization Name:HUMBLE HEALING COGNITIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-200-9289
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-0081
Mailing Address - Country:US
Mailing Address - Phone:225-400-1510
Mailing Address - Fax:
Practice Address - Street 1:38050 FALLEN OAKS DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4160
Practice Address - Country:US
Practice Address - Phone:678-200-9289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty