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General NPI Number Information
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NPI Number | 1255941902
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Entity Type | Organization
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Legal Business Name | NEW LEAF BEHAVIORAL HEALTH CLINICIANS, LLC
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Dates
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Enumeration Date | 08/07/2020
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 2905 FISKE STREET
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8550
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Country | US
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Telephone | 337-476-1338
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Fax |
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Provider Business Mailing Address
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Address Line | 2905 FISKE STREET
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8550
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Country | US
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Telephone | 337-476-1338
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. HORATIO ACQUINALDO MILLIN JR.
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Credential | MD
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Telephone | 337-476-1338
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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 |
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License Number State |
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