Basic Information
| Provider Information | |||||||||
| NPI: | 1952762205 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ENHANCED DESTINEY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2740 IBERVILLE ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701195516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048218184 | ||||||||
| FaxNumber: | 5048218185 | ||||||||
| Practice Location | |||||||||
| Address1: | 2740 IBERVILLE STREET | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048218184 | ||||||||
| FaxNumber: | 5048218185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2016 | ||||||||
| LastUpdateDate: | 03/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | PARNELL | ||||||||
| AuthorizedOfficialFirstName: | BECKY | ||||||||
| AuthorizedOfficialMiddleName: | REECE | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH PROFESSIONAL | ||||||||
| AuthorizedOfficialTelephone: | 5049142971 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MHS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 011406773 | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.