Provider Demographics
NPI:1215447859
Name:INSTAR COUNSELING OF THE NORTHSHORE
Entity type:Organization
Organization Name:INSTAR COUNSELING OF THE NORTHSHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MISTICH
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, NCC, LPC
Authorized Official - Phone:985-705-2765
Mailing Address - Street 1:408 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-8910
Mailing Address - Country:US
Mailing Address - Phone:985-705-2765
Mailing Address - Fax:
Practice Address - Street 1:22532 HIGHWAY 1088
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-8450
Practice Address - Country:US
Practice Address - Phone:985-705-7736
Practice Address - Fax:985-234-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1912248808OtherNPI