Provider Demographics
NPI:1457626269
Name:MID CITY COUNSELING, LLC
Entity type:Organization
Organization Name:MID CITY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BEAUREGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-909-5948
Mailing Address - Street 1:137 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5207
Mailing Address - Country:US
Mailing Address - Phone:504-909-5948
Mailing Address - Fax:504-309-1491
Practice Address - Street 1:137 N CLARK ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5207
Practice Address - Country:US
Practice Address - Phone:504-909-5948
Practice Address - Fax:504-309-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5040251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health