Healthcare Provider Details

I. General information

NPI: 1164254496
Provider Name (Legal Business Name): RESILIENT RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 STUBBS AVE STE C
MONROE LA
71201-5566
US

IV. Provider business mailing address

801 STUBBS AVE STE C
MONROE LA
71201-5566
US

V. Phone/Fax

Practice location:
  • Phone: 318-509-8172
  • Fax:
Mailing address:
  • Phone: 318-509-8172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHONDA BEARD
Title or Position: OWNER
Credential: FNP, PMHNP
Phone: 318-801-8868