Organization
KHONSU, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA LEE HOLMES (OWNER)
(337) 345-5390
Entity
Organization
Contact information
Practice address
3419 NW EVANGELINE TRWY STE A-1, CARENCRO, LA 70520-6241
(337) 319-1315
Mailing address
3419 NW EVANGELINE TRWY STE A-1, CARENCRO, LA 70520-6241
(337) 319-1315
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
01/23/2018
Last updated
01/22/2021
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