Healthcare Provider Details

I. General information

NPI: 1457711483
Provider Name (Legal Business Name): CANDI HILL PHD, MP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 12/15/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 STUBBS AVE
MONROE LA
71201-5628
US

IV. Provider business mailing address

1502 STUBBS AVE
MONROE LA
71201-5628
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-8700
  • Fax: 318-323-8757
Mailing address:
  • Phone: 318-323-8700
  • Fax: 318-323-8757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1322
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number324799
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: