| Mmo Of Covington, Llc | |
|
201 Greenbriar Blvd Covington LA 70433-7236 | |
| (985) 249-7780 | |
| (985) 249-7782 |
| Full Name | Mmo Of Covington, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 201 Greenbriar Blvd, Covington, Louisiana |
| Authorized Official Name and Position | Robert L. Miller (EXECUTIVE OFFICER) |
| Authorized Official Contact | 2252936774 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mmo Of Covington, Llc 728 North Blvd Baton Rouge LA 70802-5724 Ph: (225) 293-6774 | Mmo Of Covington, Llc 201 Greenbriar Blvd Covington LA 70433-7236 Ph: (985) 249-7780 |
| NPI Number | 1669428140 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 07/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669428140 | NPI | - | NPPES |
| 8303 | Other | LA | OCCUPATIONAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 194701 (Louisiana) | Primary |
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