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General NPI Number Information
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NPI Number | 1003171026
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Entity Type | Organization
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Legal Business Name | LURLINE SMITH MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 900 WILKINSON ST
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City | MANDEVILLE
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State | LA
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Zip | 70448-3533
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Country | US
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Telephone | 985-624-4450
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Fax |
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Provider Business Mailing Address
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Address Line | 900 WILKINSON ST
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City | MANDEVILLE
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State | LA
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Zip | 70448-3533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH REGIONAL DIRECTOR
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Name | MRS. TRA LADNER
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Credential | PH.D.
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Telephone | 985-624-4450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2083
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License Number State | LA
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