Healthcare Provider Details

I. General information

NPI: 1295242584
Provider Name (Legal Business Name): AMY NEVILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 SUMMA AVE
BATON ROUGE LA
70809
US

IV. Provider business mailing address

13299 LOVETT RD
BATON ROUGE LA
70818-5824
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-1970
  • Fax:
Mailing address:
  • Phone: 337-692-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: