Basic Information
| Provider Information | |||||||||
| NPI: | 1154702710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | M & M BEHAVIORAL HEALTH CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 FIRST ST | ||||||||
| Address2: | |||||||||
| City: | DELHI | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712322421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188786696 | ||||||||
| FaxNumber: | 3188786698 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 FIRST ST | ||||||||
| Address2: | |||||||||
| City: | DELHI | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712322421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188786696 | ||||||||
| FaxNumber: | 3188786698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | WANDA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6018076946 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.