Healthcare Provider Details

I. General information

NPI: 1528565967
Provider Name (Legal Business Name): MARCUS LINDSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 EVANGELINE ST
MONROE LA
71201
US

IV. Provider business mailing address

2910 EVANGELINE ST
MONROE LA
71201-3724
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-5553
  • Fax: 318-388-2190
Mailing address:
  • Phone: 239-357-1041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC9239
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: