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305 South Burnside Ave. Suite D Gonzales LA 70737 | |
| (225) 621-2760 | |
| (225) 621-2768 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 305 South Burnside Ave., Gonzales, Louisiana |
| Authorized Official Name and Position | Robert L. Miller (CEO) |
| Authorized Official Contact | 2252936774 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
728 North Blvd Baton Rouge LA 70802-5724 Ph: (225) 621-2760 | 305 South Burnside Ave. Suite D Gonzales LA 70737 Ph: (225) 621-2760 |
| NPI Number | 1093883522 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 07/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093883522 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 531032 (Louisiana) | Primary |
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