Provider Demographics
NPI:1669928453
Name:PHOENIX COUNSELING AND THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:PHOENIX COUNSELING AND THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YETTIA
Authorized Official - Middle Name:BENN
Authorized Official - Last Name:JASMINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-382-9879
Mailing Address - Street 1:1221 L B LANDRY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-2656
Mailing Address - Country:US
Mailing Address - Phone:504-382-9879
Mailing Address - Fax:504-910-9339
Practice Address - Street 1:1720 STUMPF BLVD
Practice Address - Street 2:202
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3997
Practice Address - Country:US
Practice Address - Phone:504-382-9879
Practice Address - Fax:504-910-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty