=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023787124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L & A MENTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2021
-----------------------------------------------------
Last Update Date | 09/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8055 CAPTAIN MARY MILLER DR
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71115-2948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-540-9054
-----------------------------------------------------
Fax | 318-795-8186
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8055 CAPTAIN MARY MILLER DR
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71115-2948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-540-9054
-----------------------------------------------------
Fax | 318-795-8186
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | STANCY TOMEKIO COLEMAN
-----------------------------------------------------
Credential | APRN, PMHNP
-----------------------------------------------------
Telephone | 318-540-9054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------