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General NPI Number Information
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NPI Number | 1164748208
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Entity Type | Organization
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Legal Business Name | LA BONNE MAISON, LLC
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 202 LAKE MIRIAM DRIVE SUITE E13
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City | LAKELAND
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State | FL
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Zip | 33813
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Country | US
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Telephone | 800-824-8580
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Fax | 863-619-7622
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Provider Business Mailing Address
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Address Line | 202 LAKE MIRIAM DR STE E13
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City | LAKELAND
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State | FL
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Zip | 33813-2142
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Country | US
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Telephone | 800-824-8580
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Fax | 863-619-7622
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MRS. LISA G HATTEN
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Credential |
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Telephone | 800-824-8580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH0004793
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License Number State | FL
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