|
| |
|
1313 Ringgold Avenue Coushatta LA 71019-1016 | |
| (318) 932-4029 | |
| (318) 932-5914 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1313 Ringgold Avenue, Coushatta, Louisiana |
| Authorized Official Name and Position | Allie D. Allen (DIR. OF OPERATIONS) |
| Authorized Official Contact | 3186765160 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1313 Ringgold Avenue Coushatta LA 71019-1016 Ph: (318) 932-4029 | 1313 Ringgold Avenue Coushatta LA 71019-1016 Ph: (318) 932-4029 |
| NPI Number | 1871648931 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 07/31/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871648931 | NPI | - | NPPES |
| 1710687 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 93 (Louisiana) | Primary |