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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