Basic Information
| Provider Information | |||||||||
| NPI: | 1982768263 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILESTONES MENTAL HEALTH AGENCY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4919 CANAL STREET | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044839883 | ||||||||
| FaxNumber: | 5044839082 | ||||||||
| Practice Location | |||||||||
| Address1: | 4919 CANAL STREET | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042690234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 11/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | GRIFFIN | ||||||||
| AuthorizedOfficialFirstName: | STACEY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5044839883 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.