| Gulf South Psychiatry, Llc | |
|
1924 Corporate Square Dr Suite D Slidell LA 70458-3164 | |
| (985) 781-0548 | |
| (985) 781-4319 |
| Full Name | Gulf South Psychiatry, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1924 Corporate Square Dr, Slidell, Louisiana |
| Authorized Official Name and Position | Harminder S Mallik (PRESIDENT) |
| Authorized Official Contact | 9857810548 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf South Psychiatry, Llc 1924 Corporate Square Dr Slidell LA 70458-3164 Ph: (985) 781-0548 | Gulf South Psychiatry, Llc 1924 Corporate Square Dr Suite D Slidell LA 70458-3164 Ph: (985) 781-0548 |
| NPI Number | 1568768679 |
|---|---|
| Provider Enumeration Date | 02/07/2011 |
| Last Update Date | 02/07/2011 |
| Medicare PECOS PAC ID | 1951570233 |
|---|---|
| Medicare Enrollment ID | O20110802000507 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568768679 | NPI | - | NPPES |
| MD10912R | Other | LA | STATE LICENSE10912R |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | MD10912R (Louisiana) | Primary |
| Provider Name | Rosalie E Richard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770675993 PECOS PAC ID: 1557331162 Enrollment ID: I20040730000177 |
| Provider Name | Harminder S Mallik |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336209238 PECOS PAC ID: 8628262250 Enrollment ID: I20101028000016 |
| Provider Name | Lena Maria Mason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396299368 PECOS PAC ID: 9335435353 Enrollment ID: I20190208000096 |
| Provider Name | Aaron Jeffrey Gloth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518687482 PECOS PAC ID: 3173997483 Enrollment ID: I20230327002658 |
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