Basic Information
| Provider Information | |||||||||
| NPI: | 1922484500 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHY MINDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 W JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712204543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182393890 | ||||||||
| FaxNumber: | 3182393891 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 W JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712204543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182393890 | ||||||||
| FaxNumber: | 3182393891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2015 | ||||||||
| LastUpdateDate: | 08/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | NICHOLS | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3182393890 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 5132 | LA | N | Agencies | Community/Behavioral Health | 251S00000X | 5905 | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.