Healthcare Provider Details

I. General information

NPI: 1699596262
Provider Name (Legal Business Name): EATING DISORDER TREATMENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19375 N 4TH ST
COVINGTON LA
70433-8876
US

IV. Provider business mailing address

19375 N 4TH ST
COVINGTON LA
70433-8876
US

V. Phone/Fax

Practice location:
  • Phone: 920-309-0541
  • Fax:
Mailing address:
  • Phone: 920-309-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY E MEYERS
Title or Position: CEO
Credential: LPC
Phone: 920-309-0541