MEDICARE: INGRID AUTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1396108593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID AUTIN

Provider Business Mailing Address
First Line	:	608 N SAINT PATRICK ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-4432
Country	:	US
Telephone Number	:	225-275-3039
Fax Number	:	225-275-9086

Provider Business Practice Location Address
First Line	:	608 N SAINT PATRICK ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-4432
Country	:	US
Telephone Number	:	225-275-3039
Fax Number	:	225-275-9086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	04/04/2016

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