| Easy Living Behavioral Health | |
|
1109 Carter St Ste 8 Vidalia LA 71373-3227 | |
| (318) 734-0034 | |
| (318) 734-0035 |
| Full Name | Easy Living Behavioral Health |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1109 Carter St Ste 8, Vidalia, Louisiana |
| Authorized Official Name and Position | Lisa Nichols (ADMINISTRATOR) |
| Authorized Official Contact | 3183760729 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Easy Living Behavioral Health 1109 Carter St Ste 8 Vidalia LA 71373-3227 Ph: (318) 734-0034 | Easy Living Behavioral Health 1109 Carter St Ste 8 Vidalia LA 71373-3227 Ph: (318) 734-0034 |
| NPI Number | 1780191486 |
|---|---|
| Provider Enumeration Date | 01/03/2018 |
| Last Update Date | 01/03/2018 |
| Medicare PECOS PAC ID | 6709135197 |
|---|---|
| Medicare Enrollment ID | O20180817001785 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780191486 | NPI | - | NPPES |
| 5782381 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Carole Buckles |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821409103 PECOS PAC ID: 7214286475 Enrollment ID: I20210712003311 |
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