NPIMap

Organization Active NPI

Lasting Impression Therapeutic Counseling Center, LLC

  • Community/Behavioral Health Agency
  • Lake Charles, LA
National Provider Identifier
1215349816
Registry record updated Mar 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
2203783804 Issued in LA
Legal business name
LASTING IMPRESSION THERAPEUTIC COUNSELING CENTER, LLC
Practice address
2805 5TH Ave
Lake Charles, LA 70601-7913
Phone
(337) 429-5672
Fax
(337) 429-5657
NPI assigned
May 30, 2014
Last updated
Mar 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Natalia Butler, CART, DS
Title
Founder/Ceo
Phone
(337) 377-8225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 2203783804 LA Primary

Addresses

Primary practice location

2805 5TH Ave
Lake Charles, LA 70601-7913

Mailing address

2805 5TH Ave
Lake Charles, LA 70601-7913
Phone (337) 377-8225

Other identifiers 1

IdentifierTypeStateIssuer
2203783804MedicaidLA

National Provider Directory

National Provider Directory

Locations

2805 5th Ave
Lake Charles, LA 70601
Phone (337) 429-5672

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521676800000",
    "number": "1215349816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 5TH AVE",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017913",
            "telephone_number": "337-377-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 5TH AVE",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017913",
            "telephone_number": "337-429-5672",
            "fax_number": "337-429-5657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASTING IMPRESSION THERAPEUTIC COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-30",
        "last_updated": "2018-03-22",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "NATALIA",
        "authorized_official_title_or_position": "FOUNDER/CEO",
        "authorized_official_telephone_number": "337-377-8225",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CART, DS"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "LA",
            "license": "2203783804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2203783804",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.