Provider Demographics
NPI:1215652961
Name:FOOTPRINTS COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:FOOTPRINTS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REASON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:985-507-0311
Mailing Address - Street 1:2206 RUE SIMONE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5730
Mailing Address - Country:US
Mailing Address - Phone:985-507-0311
Mailing Address - Fax:
Practice Address - Street 1:2206 RUE SIMONE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5730
Practice Address - Country:US
Practice Address - Phone:985-507-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600915818Medicaid