Provider Demographics
NPI:1104881564
Name:ACTIVE INTERVENTION, INC.
Entity type:Organization
Organization Name:ACTIVE INTERVENTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:MCCLELLAND
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-367-5766
Mailing Address - Street 1:1799 STUMPF BLVD
Mailing Address - Street 2:BLDG. 7 STE. 10
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3950
Mailing Address - Country:US
Mailing Address - Phone:504-367-5766
Mailing Address - Fax:504-367-5755
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:BLDG. 7 STE. 10
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:504-367-5766
Practice Address - Fax:504-367-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty