Provider Demographics
NPI:1053131888
Name:ARISE THERAPY LLC
Entity type:Organization
Organization Name:ARISE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GULLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RAC
Authorized Official - Phone:318-680-0375
Mailing Address - Street 1:217 ALTA MIRA DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-9798
Mailing Address - Country:US
Mailing Address - Phone:318-680-0375
Mailing Address - Fax:
Practice Address - Street 1:1110 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4334
Practice Address - Country:US
Practice Address - Phone:318-680-0375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty