Basic Information
| Provider Information | |||||||||
| NPI: | 1538692488 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENTAL FITNESS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4322 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701195945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044347655 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Practice Location | |||||||||
| Address1: | 4322 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701195945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044347655 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | RIVAS | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | LPC/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5044347655 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5278 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.