Healthcare Provider Details

I. General information

NPI: 1356083307
Provider Name (Legal Business Name): MICHELLE MARIE NED DBH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 SOUTHFORK AVENUE APARTMENT 3095
BATON ROUGE LA
70816
US

IV. Provider business mailing address

11555 SOUTHFORK AVENUE APARTMENT 3095
BATON ROUGE LA
70816
US

V. Phone/Fax

Practice location:
  • Phone: 337-854-5071
  • Fax: 337-474-0623
Mailing address:
  • Phone: 337-854-5071
  • Fax: 337-474-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: