Bobby Church, LPC, NCC

Individual provider Active NPI Professional Counselor · Farmerville, LA

NPI 1013451830 · NPPES record last updated Dec 13, 2016

Key facts

NPI
1013451830
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
LPC#4604 (LA)
Practice address
107 Miller St
Farmerville, LA 71241-2311
Phone
(318) 368-4755
Fax
(318) 982-8050
NPI assigned
Dec 13, 2016
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LPC#4604LAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Safe Haven Counseling, LLC Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC#4604 LA Yes

Addresses

Primary practice location

107 Miller St
Farmerville, LA 71241-2311

Mailing address

107 Miller Street
Farmerville, LA 71241-2311
Phone (318) 368-4755

Other providers in Farmerville, LA

All providers in Farmerville, LA · Professional Counselor in Louisiana

Sources for this page

Verify at the official NPI Registry.