| Family Life Developmental Center | |
|
829 E Georgia Ave Ste 5 Ruston LA 71270-3901 | |
| (318) 255-8405 | |
| (318) 255-8417 |
| Full Name | Family Life Developmental Center |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 829 E Georgia Ave Ste 5, Ruston, Louisiana |
| Authorized Official Name and Position | Alphonso Bingham (ADMINISTRATOR/CEO) |
| Authorized Official Contact | 3182558405 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Life Developmental Center 829 E Georgia Ave Ste 5 Ruston LA 71270-3901 Ph: (318) 255-8405 | Family Life Developmental Center 829 E Georgia Ave Ste 5 Ruston LA 71270-3901 Ph: (318) 255-8405 |
| NPI Number | 1679858054 |
|---|---|
| Provider Enumeration Date | 10/17/2011 |
| Last Update Date | 10/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679858054 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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