| Mccormack Enterprise, Llc | |
|
1003 Sherwood Dr Ruston LA 71270-2135 | |
| (318) 237-8216 | |
| Not Available |
| Full Name | Mccormack Enterprise, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1003 Sherwood Dr, Ruston, Louisiana |
| Authorized Official Name and Position | Joshua Ray Mccormack (OWNER) |
| Authorized Official Contact | 3182378216 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mccormack Enterprise, Llc 1003 Sherwood Dr Ruston LA 71270-2135 Ph: (318) 237-8216 | Mccormack Enterprise, Llc 1003 Sherwood Dr Ruston LA 71270-2135 Ph: (318) 237-8216 |
| NPI Number | 1992337976 |
|---|---|
| Provider Enumeration Date | 02/07/2020 |
| Last Update Date | 02/07/2020 |
| Certification Date | 02/07/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992337976 | NPI | - | NPPES |
| 2442210 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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