Basic Information
| Provider Information | |||||||||
| NPI: | 1902579675 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOTAL WELLNESS URGENT PSYCHIATRIC CARE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 343 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712203849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185985040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 343 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712203849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185985040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2021 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | LANIER | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8176024389 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.