Basic Information
| Provider Information | |||||||||
| NPI: | 1801529243 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNLIMITED WELLBEING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 295 BLUE HERON RD | ||||||||
| Address2: | |||||||||
| City: | DUBACH | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712353429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182353294 | ||||||||
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| Practice Location | |||||||||
| Address1: | 295 BLUE HERON RD | ||||||||
| Address2: | |||||||||
| City: | DUBACH | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712353429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182353294 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2022 | ||||||||
| LastUpdateDate: | 07/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | DAVIDSON | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3182353294 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN-PMHNP-BC | ||||||||
| NPICertificationDate: | 07/04/2022 | ||||||||
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.