Basic Information
| Provider Information | |||||||||
| NPI: | 1023787124 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | L & A MENTAL HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8055 CAPTAIN MARY MILLER DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711152948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185409054 | ||||||||
| FaxNumber: | 3187958186 | ||||||||
| Practice Location | |||||||||
| Address1: | 8055 CAPTAIN MARY MILLER DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711152948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185409054 | ||||||||
| FaxNumber: | 3187958186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2021 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | COLEMAN | ||||||||
| AuthorizedOfficialFirstName: | STANCY | ||||||||
| AuthorizedOfficialMiddleName: | TOMEKIO | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3185409054 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN, PMHNP | ||||||||
| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.