Healthcare Provider Details

I. General information

NPI: 1659757714
Provider Name (Legal Business Name): KIMBERLY C. FORCINEL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 LINWOOD AVE
STONEWALL LA
71078-9161
US

IV. Provider business mailing address

721 LINWOOD AVE
STONEWALL LA
71078-9161
US

V. Phone/Fax

Practice location:
  • Phone: 318-455-2080
  • Fax:
Mailing address:
  • Phone: 318-455-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberAP08461
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberAP08461
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberAP08461
License Number StateLA

VIII. Authorized Official

Name: KIMBERLY COPELAND FORCINEL
Title or Position: MANAGER
Credential: PMHNP
Phone: 318-455-2080