Healthcare Provider Details

I. General information

NPI: 1750672390
Provider Name (Legal Business Name): THERAPEUTIC MEDICAL & PSYCHIATRIC SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2011
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 STUBBS AVE
MONROE LA
71292-1106
US

IV. Provider business mailing address

200 WINTERPARK DR
WEST MONROE LA
71292-1106
US

V. Phone/Fax

Practice location:
  • Phone: 318-396-9712
  • Fax: 180-051-8423
Mailing address:
  • Phone: 318-396-9712
  • Fax: 180-051-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO5002
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANE PRIVITOR PRIVITOR DAVIS
Title or Position: OWNER
Credential: APRN, FNP-C, PMHNPBC
Phone: 318-816-5116