Provider Demographics
NPI:1235968058
Name:POSITIVE HEADSPACE LLC
Entity type:Organization
Organization Name:POSITIVE HEADSPACE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LEWIS-GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:504-813-2298
Mailing Address - Street 1:1801 MANHATTAN BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-7301
Mailing Address - Country:US
Mailing Address - Phone:504-813-2298
Mailing Address - Fax:504-267-2491
Practice Address - Street 1:120 LAKE LYNN DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5273
Practice Address - Country:US
Practice Address - Phone:504-782-4347
Practice Address - Fax:504-267-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty