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Organization
FAIRWAY COUNSELING AGENCY, INC.
Active
Organization
FAIRWAY COUNSELING AGENCY, INC.
Active
Other names
Phoenix Family Life Centers
Organization subpart
No
Provider details
NPI number
Authorized official
GEMMALYN PRYOR (SEASIDE HC BILLING SUPERVISOR)
(337) 234-8280
Entity
Organization
Contact information
Practice address
710 VERSAILLES BLVD, ALEXANDRIA, LA 71303-2351
(318) 449-4474
Mailing address
101 FEU FOLLET RD STE 100, LAFAYETTE, LA 70508-4234
(337) 234-8455
(318) 449-4472
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1803871
—
LA
Enumeration date
10/07/2011
Last updated
06/30/2023
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