| Living Water Counseling Center | |
|
4016 Holly Hill Rd Lake Charles LA 70605-2533 | |
| (337) 284-9779 | |
| (337) 282-7967 |
| Full Name | Living Water Counseling Center |
|---|---|
| Speciality | Counselor |
| Location | 4016 Holly Hill Rd, Lake Charles, Louisiana |
| Authorized Official Name and Position | Lisa Brune (CEO/COUNSELOR) |
| Authorized Official Contact | 3372849779 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Water Counseling Center 4016 Holly Hill Rd Lake Charles LA 70605-2533 Ph: (337) 284-9779 | Living Water Counseling Center 4016 Holly Hill Rd Lake Charles LA 70605-2533 Ph: (337) 284-9779 |
| NPI Number | 1588083687 |
|---|---|
| Provider Enumeration Date | 04/16/2014 |
| Last Update Date | 05/08/2023 |
| Certification Date | 05/08/2023 |
| Medicare PECOS PAC ID | 4880826163 |
|---|---|
| Medicare Enrollment ID | O20140421001574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588083687 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 10755 (Louisiana) | Primary |
| Provider Name | Lisa J Brune |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205066479 PECOS PAC ID: 9830321124 Enrollment ID: I20140421001833 |
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