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General NPI Number Information
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NPI Number | 1093049280
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Entity Type | Organization
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Legal Business Name | LIFENET BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 4070 LONESOME RD SUITE B
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City | MANDEVILLE
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State | LA
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Zip | 70448-7085
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Country | US
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Telephone | 985-246-2600
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Fax | 985-246-2601
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Provider Business Mailing Address
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Address Line | 4070 LONESOME RD SUITE B
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City | MANDEVILLE
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State | LA
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Zip | 70448-7085
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Country | US
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Telephone | 985-246-2600
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Fax | 985-246-2601
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | WESLEY EHRETT MCCLAIN
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Credential |
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Telephone | 985-246-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 020750
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License Number State | LA
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