Basic Information
Provider Information | |||||||||
NPI: | 1477758852 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MOUNT | ||||||||
FirstName: | LISA | ||||||||
MiddleName: | JANETTE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW, BACS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | COOPER | ||||||||
OtherFirstName: | LISA | ||||||||
OtherMiddleName: | JANETTE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 104 WOODRIDGE CIR | ||||||||
Address2: |   | ||||||||
City: | PINEVILLE | ||||||||
State: | LA | ||||||||
PostalCode: | 713604564 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3187040640 | ||||||||
FaxNumber: | 3187040642 | ||||||||
Practice Location | |||||||||
Address1: | 1403 METRO DR STE G | ||||||||
Address2: |   | ||||||||
City: | ALEXANDRIA | ||||||||
State: | LA | ||||||||
PostalCode: | 713013446 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3187040640 | ||||||||
FaxNumber: | 3187040642 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/18/2007 | ||||||||
LastUpdateDate: | 10/19/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 8162 | LA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.