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General NPI Number Information
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NPI Number | 1326875931
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Entity Type | Organization
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Legal Business Name | MATS CLINIC LLC
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 624 CONNELL PARK LN STE A1
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City | BATON ROUGE
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State | LA
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Zip | 70806-6534
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Country | US
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Telephone | 225-468-6287
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Fax | 225-443-4733
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Provider Business Mailing Address
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Address Line | 624 CONNELL PARK LN STE A1
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City | BATON ROUGE
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State | LA
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Zip | 70806-6534
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Country | US
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Telephone | 225-468-6287
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Fax | 225-251-4502
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | KATELYN MELANCON
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Credential |
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Telephone | 225-468-6287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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