| Bayou Mental Health Services, Llc. | |
|
818 Main St Pineville LA 71360-6409 | |
| (318) 443-9035 | |
| (318) 443-9037 |
| Full Name | Bayou Mental Health Services, Llc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 818 Main St, Pineville, Louisiana |
| Authorized Official Name and Position | Latonya Charles (ADMINISTRATOR) |
| Authorized Official Contact | 3373532129 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bayou Mental Health Services, Llc. 818 Main St Suite A Pineville LA 71360-6409 Ph: (318) 443-9035 | Bayou Mental Health Services, Llc. 818 Main St Pineville LA 71360-6409 Ph: (318) 443-9035 |
| NPI Number | 1518306000 |
|---|---|
| Provider Enumeration Date | 06/18/2013 |
| Last Update Date | 06/18/2013 |
| Medicare PECOS PAC ID | 8123446887 |
|---|---|
| Medicare Enrollment ID | O20201005001450 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518306000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Louisiana) | Primary |
| Provider Name | Bryan Bolwahnn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043247331 PECOS PAC ID: 6406822527 Enrollment ID: I20040909000280 |
| Provider Name | Jennifer White Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558752303 PECOS PAC ID: 3173840907 Enrollment ID: I20150316001677 |
| Provider Name | Marguerite R Wilcox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174005078 PECOS PAC ID: 3577977743 Enrollment ID: I20210129000351 |
| Provider Name | Latonya Scriven Charles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093003899 PECOS PAC ID: 3971922378 Enrollment ID: I20210203002649 |
| Provider Name | Leon Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598091605 PECOS PAC ID: 8527456011 Enrollment ID: I20211103000742 |
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