Healthcare Provider Details

I. General information

NPI: 1336681659
Provider Name (Legal Business Name): MELANIE MANN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 07/12/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44478 N HART RD
HAMMOND LA
70403-0260
US

IV. Provider business mailing address

44478 N HART RD
HAMMOND LA
70403-0260
US

V. Phone/Fax

Practice location:
  • Phone: 985-363-6202
  • Fax:
Mailing address:
  • Phone: 985-363-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number15701
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15701
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number15701
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: