Healthcare Provider Details

I. General information

NPI: 1013314012
Provider Name (Legal Business Name): 360 MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 EAST MAIN STREET SUITE D
NEW IBERIA LA
70560
US

IV. Provider business mailing address

1614 EAST MAIN STREET SUITE D
NEW IBERIA LA
70560
US

V. Phone/Fax

Practice location:
  • Phone: 337-256-5917
  • Fax:
Mailing address:
  • Phone: 337-256-5917
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. TIFFANY LOUISE BROWN
Title or Position: OWNER
Credential: LPC
Phone: 337-256-3129