Provider Demographics
NPI:1285145912
Name:BODY MIND AND SPIRIT COUNSELING & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:BODY MIND AND SPIRIT COUNSELING & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLEAUDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAC, NCC
Authorized Official - Phone:225-343-4343
Mailing Address - Street 1:1746 MAY ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2073
Mailing Address - Country:US
Mailing Address - Phone:225-343-4343
Mailing Address - Fax:
Practice Address - Street 1:8738 QUARTERS LAKE RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2194
Practice Address - Country:US
Practice Address - Phone:225-276-6982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5804101YP2500X
LA1555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty