Healthcare Provider Details

I. General information

NPI: 1346164217
Provider Name (Legal Business Name): NEUROVANA PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CHAMALE CV E
SLIDELL LA
70460-2545
US

IV. Provider business mailing address

48 CHAMALE CV E
SLIDELL LA
70460-2545
US

V. Phone/Fax

Practice location:
  • Phone: 216-314-0733
  • Fax:
Mailing address:
  • Phone: 216-314-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN P MCCLINTOCK
Title or Position: OWNER
Credential: PHD
Phone: 216-314-0733