Integrated Wellness Clinic | |
10473 Old Hammond Hwy Baton Rouge LA 70816-8264 | |
(252) 924-1910 | |
(225) 924-1988 |
Full Name | Integrated Wellness Clinic |
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Speciality | Counselor |
Location | 10473 Old Hammond Hwy, Baton Rouge, Louisiana |
Authorized Official Name and Position | Shannon L Boling (OPERATIONS OFFICE) |
Authorized Official Contact | 6124839782 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Integrated Wellness Clinic 10473 Old Hammond Hwy Baton Rouge LA 70816-8264 Ph: (252) 924-1910 | Integrated Wellness Clinic 10473 Old Hammond Hwy Baton Rouge LA 70816-8264 Ph: (252) 924-1910 |
NPI Number | 1548602097 |
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Provider Enumeration Date | 07/25/2013 |
Last Update Date | 04/30/2018 |
Medicare PECOS PAC ID | 2961759121 |
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Medicare Enrollment ID | O20180718003006 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548602097 | NPI | - | NPPES |
2222222 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101Y00000X | Counselor | (* (Not Available)) | Primary |
Provider Name | Amy L Copeland |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1396017778 PECOS PAC ID: 8325327992 Enrollment ID: I20161123000314 |
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