Provider Demographics
NPI:1770101883
Name:PURE MIND COUNSELING & WELLNESS, LLC
Entity type:Organization
Organization Name:PURE MIND COUNSELING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, LPC-S
Authorized Official - Prefix:
Authorized Official - First Name:SHANTELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:225-217-2898
Mailing Address - Street 1:4875 S SHERWOOD FOREST BLVD STE D1
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4640
Mailing Address - Country:US
Mailing Address - Phone:225-217-2898
Mailing Address - Fax:504-500-9412
Practice Address - Street 1:4875 S SHERWOOD FOREST BLVD STE D1
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4640
Practice Address - Country:US
Practice Address - Phone:225-217-2898
Practice Address - Fax:504-500-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health