| None | |
|
400 Preston Blvd Bossier City LA 71111 | |
| (318) 588-8189 | |
| Not Available |
| Full Name | None |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 400 Preston Blvd, Bossier City, Louisiana |
| Authorized Official Name and Position | Tara Dupont (OWNER) |
| Authorized Official Contact | 3185888189 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 2909 Donald Dr Bossier City LA 71112-2711 Ph: (318) 588-5189 | None 400 Preston Blvd Bossier City LA 71111 Ph: (318) 588-8189 |
| NPI Number | 1548038599 |
|---|---|
| Provider Enumeration Date | 12/19/2023 |
| Last Update Date | 02/26/2024 |
| Certification Date | 02/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548038599 | NPI | - | NPPES |
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