Healthcare Provider Details

I. General information

NPI: 1881190858
Provider Name (Legal Business Name): CECILIA MCMULLEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19184 DR JOHN LAMBERT DR STE 105
HAMMOND LA
70403-0936
US

IV. Provider business mailing address

19184 DR JOHN LAMBERT DR STE 105
HAMMOND LA
70403-0936
US

V. Phone/Fax

Practice location:
  • Phone: 985-549-1900
  • Fax: 985-549-1888
Mailing address:
  • Phone: 985-549-1900
  • Fax: 985-549-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA8818
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: