Basic Information
| Provider Information | |||||||||
| NPI: | 1134665813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OAKES | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | JOHNSON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 S BROAD ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043099991 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 S BROAD ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855429949 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2017 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.