Provider Demographics
NPI:1588933436
Name:REACHING AT POTENTIAL
Entity type:Organization
Organization Name:REACHING AT POTENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQULINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NWUFOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-512-2857
Mailing Address - Street 1:1651 LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6031
Mailing Address - Country:US
Mailing Address - Phone:318-654-7075
Mailing Address - Fax:318-654-7075
Practice Address - Street 1:1651 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6031
Practice Address - Country:US
Practice Address - Phone:318-654-7075
Practice Address - Fax:318-654-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management