Provider Demographics
NPI:1003798901
Name:MIND REWIRED PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:MIND REWIRED PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VASILIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:LABONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PLPC
Authorized Official - Phone:225-395-1948
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-0193
Mailing Address - Country:US
Mailing Address - Phone:225-395-1948
Mailing Address - Fax:
Practice Address - Street 1:105 NW RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70404-5001
Practice Address - Country:US
Practice Address - Phone:225-395-1948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty