Healthcare Provider Details

I. General information

NPI: 1821472879
Provider Name (Legal Business Name): ACCESS HEALTH LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 INDIANA AVE
KENNER LA
70065-4605
US

IV. Provider business mailing address

2900 INDIANA AVE
KENNER LA
70065-4605
US

V. Phone/Fax

Practice location:
  • Phone: 504-575-3712
  • Fax: 504-575-3691
Mailing address:
  • Phone: 504-575-3700
  • Fax: 504-575-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMD.206029
License Number StateLA

VIII. Authorized Official

Name: MARK KEISER
Title or Position: PRESIDENT
Credential:
Phone: 504-575-3700