Provider Demographics
NPI:1386240166
Name:FORENSIC THERAPY WELLNESS, LLC
Entity type:Organization
Organization Name:FORENSIC THERAPY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW-BACS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-BACS
Authorized Official - Phone:985-856-5144
Mailing Address - Street 1:619 DUVAL AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3103
Mailing Address - Country:US
Mailing Address - Phone:985-856-5144
Mailing Address - Fax:
Practice Address - Street 1:619 DUVAL AVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-3103
Practice Address - Country:US
Practice Address - Phone:985-856-5144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty