NPIMap

Organization Active NPI

Creator Destiny LLC

  • Professional Counselor
  • Kenner, LA
National Provider Identifier
1669861043
Registry record updated Mar 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
4469 Issued in LA
Legal business name
CREATOR DESTINY LLC
Practice address
503 E Loyola Dr
Kenner, LA 70065-4119
Phone
(504) 220-8442
NPI assigned
Jan 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2015

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

Authorized official

Name
Yolanda Annette BonnerNPI 1760871891
Title
Owner
Phone
(504) 220-8442

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 4469 LA
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 4469 LA Primary
Community/Behavioral Health Agency 251S00000X 4469 LA
Preferred Provider Organization 305R00000X 4469 LA

Addresses

Primary practice location

503 E Loyola Dr
Kenner, LA 70065-4119

Mailing address

PO Box 2353
Kenner, LA 70063-2353
Phone (504) 220-8442

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1669861043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2353",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700632353",
            "telephone_number": "504-220-8442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 E LOYOLA DR",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700654119",
            "telephone_number": "504-220-8442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATOR DESTINY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "YOLANDA",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-220-8442"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "LA",
            "license": "4469",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "4469",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "LA",
            "license": "4469",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "LA",
            "license": "4469",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenner, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.