Healthcare Provider Details

I. General information

NPI: 1154702710
Provider Name (Legal Business Name): M & M BEHAVIORAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 FIRST ST
DELHI LA
71232-2421
US

IV. Provider business mailing address

712 FIRST ST
DELHI LA
71232-2421
US

V. Phone/Fax

Practice location:
  • Phone: 318-878-6696
  • Fax: 318-878-6698
Mailing address:
  • Phone: 318-878-6696
  • Fax: 318-878-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: WANDA D MARTIN
Title or Position: OWNER
Credential:
Phone: 601-807-6946