Provider Demographics
NPI:1578308581
Name:PIVOTAL MOMENTS XTRA MILES
Entity type:Organization
Organization Name:PIVOTAL MOMENTS XTRA MILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SCHOLAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:337-308-4574
Mailing Address - Street 1:530 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5002
Mailing Address - Country:US
Mailing Address - Phone:337-308-4574
Mailing Address - Fax:337-284-3034
Practice Address - Street 1:530 S COURT ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5002
Practice Address - Country:US
Practice Address - Phone:337-308-4574
Practice Address - Fax:337-284-3034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIVOTAL MOMENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty