Provider Demographics
NPI:1548894173
Name:SALT AND LIGHT COLLABORATIVE, INC.
Entity type:Organization
Organization Name:SALT AND LIGHT COLLABORATIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:CRYSTAL
Authorized Official - Last Name:ESTE-MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:337-426-1144
Mailing Address - Street 1:114 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5718
Mailing Address - Country:US
Mailing Address - Phone:337-853-2789
Mailing Address - Fax:337-422-4295
Practice Address - Street 1:114 STATE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5718
Practice Address - Country:US
Practice Address - Phone:337-426-1144
Practice Address - Fax:337-422-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No333600000XSuppliersPharmacy
No251S00000XAgenciesCommunity/Behavioral Health