Healthcare Provider Details

I. General information

NPI: 1376467902
Provider Name (Legal Business Name): NORTHEAST LOUISIANA CENTER FOR EATING DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
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: 318-232-0741
  • Fax: 318-383-0889
Mailing address:
  • Phone: 318-232-0741
  • Fax: 318-383-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL FOX
Title or Position: OWNER
Credential: MS, RD, LDN, IEDS
Phone: 318-232-0741