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1026 E Worthy St Suite A Gonzales LA 70737-4302 | |
| (225) 450-6616 | |
| (225) 450-6615 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1026 E Worthy St, Gonzales, Louisiana |
| Authorized Official Name and Position | Laura A Gonzales (OWNER) |
| Authorized Official Contact | 2254506616 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1026 E Worthy St Suite A Gonzales LA 70737-4302 Ph: (225) 450-6616 | 1026 E Worthy St Suite A Gonzales LA 70737-4302 Ph: (225) 450-6616 |
| NPI Number | 1861811861 |
|---|---|
| Provider Enumeration Date | 04/08/2014 |
| Last Update Date | 09/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861811861 | NPI | - | NPPES |
| 2394517 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 10953 (Louisiana) | Primary |
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