MEDICARE: COMPREHENSIVE MENTAL HEALTH CENTER OF BATON ROUGE, INC.

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1639499213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE MENTAL HEALTH CENTER OF BATON ROUGE, INC.

Provider Business Mailing Address
First Line	:	5550 THOMAS RD
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70811-7354
Country	:	US
Telephone Number	:	225-778-1100
Fax Number	:	225-778-1199

Provider Business Practice Location Address
First Line	:	5550 THOMAS RD
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70811-7354
Country	:	US
Telephone Number	:	225-778-1100
Fax Number	:	225-778-1199

Authorized Official
Title or Position	:	CEO
Name	:	MARK J CULLEN
Credential	:
Telephone Number	:	337-788-3330

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	06/07/2010

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