Healthcare Provider Details

I. General information

NPI: 1316091572
Provider Name (Legal Business Name): RUSTON MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 WHITE ST
RUSTON LA
71270
US

IV. Provider business mailing address

316 SAINT CHARLES ST
JONESBORO LA
71251-2344
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-4150
  • Fax:
Mailing address:
  • Phone: 318-259-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number137
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNY LEIGH GRIGGS
Title or Position: LPN2
Credential: LPN
Phone: 318-251-4150