=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316693963
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYPRESS HEALTH CONSULTANTS PROFESSIONAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2022
-----------------------------------------------------
Last Update Date | 02/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 VERSAILLES BLVD
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71303-3960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-657-4340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 123 HIDDEN PATH DR
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71360-2202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-534-0219
-----------------------------------------------------
Fax | 337-534-0220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NP
-----------------------------------------------------
Name | MICHAEL MCGEHEE
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 337-534-0219
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------