Basic Information
| Provider Information | |||||||||
| NPI: | 1992227425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANCHOR MENTAL HEALTH AND WELLNESS, PLLC | ||||||||
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| OtherOrganizationName: | ANCHOR MENTAL HEALTH AND WELLNESS, PLLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 HEISLER ST | ||||||||
| Address2: | |||||||||
| City: | PORT NECHES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776512246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097208709 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4250 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706073900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374747581 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2017 | ||||||||
| LastUpdateDate: | 09/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | CARSON | ||||||||
| AuthorizedOfficialFirstName: | BETHANNE | ||||||||
| AuthorizedOfficialMiddleName: | FONDREN | ||||||||
| AuthorizedOfficialTitleorPosition: | PMHNP | ||||||||
| AuthorizedOfficialTelephone: | 4097208709 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHMNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP09425 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.