Healthcare Provider Details

I. General information

NPI: 1750482469
Provider Name (Legal Business Name): COMPREHENSIVE MENTAL HEALTH CENTER OF MONROE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 THOMAS RD SUITES C & D
WEST MONROE LA
71292-5816
US

IV. Provider business mailing address

1301 THOMAS RD SUITES C & D
WEST MONROE LA
71292-5816
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-9455
  • Fax: 318-329-9492
Mailing address:
  • Phone: 318-329-9455
  • Fax: 318-329-9492

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 State

VIII. Authorized Official

Name: MR. CARLTON OTIS NOBLE
Title or Position: PROGRAM DIRECTOR/MEMBER
Credential: R.N.
Phone: 318-329-9455