Basic Information
| Provider Information | |||||||||
| NPI: | 1790323095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIND CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 BASS RD | ||||||||
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| City: | LEESVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714466545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373532282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 108 CONSTITUTION DR | ||||||||
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| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713033521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187040640 | ||||||||
| FaxNumber: | 3187040642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2019 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | CZUDEK | ||||||||
| AuthorizedOfficialFirstName: | ALYSSA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | APRN, PMHNP-BC | ||||||||
| AuthorizedOfficialTelephone: | 3187040640 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/17/2019 | ||||||||
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.