Individual
MR. JASON TY CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT, LPC
Contact information
Practice address
480 ROBERT BLVD, SLIDELL, LA 70458-1345
(985) 649-2774
(985) 649-2738
Mailing address
480 ROBERT BLVD, SLIDELL, LA 70458-1345
(985) 649-2774
(985) 649-2738
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2412
LA
106H00000X
Marriage & Family Therapist
MFT25
LA
Other
Enumeration date
04/23/2007
Last updated
01/22/2014
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