| Champion Mindset, Llc | |
|
352 Terrace Hill Dr Jonesboro LA 71251-3031 | |
| (318) 239-9269 | |
| Not Available |
| Full Name | Champion Mindset, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 352 Terrace Hill Dr, Jonesboro, Louisiana |
| Authorized Official Name and Position | Jhazzman M Martin (CEO) |
| Authorized Official Contact | 3184970846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Champion Mindset, Llc 352 Terrace Hill Dr Jonesboro LA 71251-3031 Ph: () - | Champion Mindset, Llc 352 Terrace Hill Dr Jonesboro LA 71251-3031 Ph: (318) 239-9269 |
| NPI Number | 1144055054 |
|---|---|
| Provider Enumeration Date | 09/03/2024 |
| Last Update Date | 09/03/2024 |
| Certification Date | 09/03/2024 |
| Medicare PECOS PAC ID | 5799218509 |
|---|---|
| Medicare Enrollment ID | O20241101000246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144055054 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jhazzman Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639812563 PECOS PAC ID: 9234662040 Enrollment ID: I20241101000487 |
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