Healthcare Provider Details

I. General information

NPI: 1245171479
Provider Name (Legal Business Name): COTTON-LAYTON SOUTH WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 ORANGE ST
MONROE LA
71202-2325
US

IV. Provider business mailing address

1511 ORANGE ST
MONROE LA
71202-2325
US

V. Phone/Fax

Practice location:
  • Phone: 318-914-6744
  • Fax: 318-610-1019
Mailing address:
  • Phone: 318-914-6744
  • Fax: 318-610-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KALETHIA BUSH
Title or Position: FOUNDER/CEO
Credential:
Phone: 318-914-6744