Healthcare Provider Details

I. General information

NPI: 1598289399
Provider Name (Legal Business Name): NU VISION BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 STUMPF BLVD BLDG 5 STE 6
TERRYTOWN LA
70056
US

IV. Provider business mailing address

1799 STUMPF BLVD BLDG 5 STE 6
TERRYTOWN LA
70056-3950
US

V. Phone/Fax

Practice location:
  • Phone: 504-301-0811
  • Fax: 504-301-3364
Mailing address:
  • Phone: 504-301-0811
  • Fax: 504-301-3364

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: STACEY PHELPS
Title or Position: OWNER
Credential:
Phone: 504-301-0811