Provider Demographics
NPI:1447512512
Name:PEACEFUL ALTERNATIVES COUNSELING AND THERAPY, LLC
Entity type:Organization
Organization Name:PEACEFUL ALTERNATIVES COUNSELING AND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATION/ MHP
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:318-670-8898
Mailing Address - Street 1:PO BOX 29372
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71149
Mailing Address - Country:US
Mailing Address - Phone:318-670-8898
Mailing Address - Fax:318-300-3772
Practice Address - Street 1:5902 BUNCOMBE RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-4004
Practice Address - Country:US
Practice Address - Phone:318-670-8898
Practice Address - Fax:318-300-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LABH0012168OtherLOUISIANA DEPARTMENT OF HEALTH: BEHAVIORAL HEALTH
LABH0011860OtherLOUISIANA DEPARTMENT OF HEALTH: BEHAVIORAL HEALTH LICENSE