Healthcare Provider Details

I. General information

NPI: 1073747374
Provider Name (Legal Business Name): NURSING HOME PSYCHOLOGICAL SERVICES OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CONSTELLATION DR
SLIDELL LA
70458-9029
US

IV. Provider business mailing address

398 E COLUMBUS ST
DADEVILLE AL
36853-1402
US

V. Phone/Fax

Practice location:
  • Phone: 256-825-4135
  • Fax: 256-825-4137
Mailing address:
  • Phone: 256-825-4135
  • Fax: 256-825-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RODNEY D HESSON
Title or Position: OWNER
Credential: PSY.D.
Phone: 256-825-4135