Provider Demographics
NPI:1982392262
Name:SERENITY CHILD AND YOUTH COUNSELING, LLC
Entity Type:Organization
Organization Name:SERENITY CHILD AND YOUTH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:337-348-1133
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:ROSEPINE
Mailing Address - State:LA
Mailing Address - Zip Code:70659-0092
Mailing Address - Country:US
Mailing Address - Phone:337-348-1133
Mailing Address - Fax:
Practice Address - Street 1:725 WEST DRIVE
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634
Practice Address - Country:US
Practice Address - Phone:337-348-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty