=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346744828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELLE ESPRIT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2018
-----------------------------------------------------
Last Update Date | 03/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1535 W MAIN ST STE 2
-----------------------------------------------------
City | VILLE PLATTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70586-2868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-363-2294
-----------------------------------------------------
Fax | 337-363-2295
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1535 W MAIN ST STE 2
-----------------------------------------------------
City | VILLE PLATTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70586-2868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-363-2294
-----------------------------------------------------
Fax | 337-363-2295
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | LAURI GUILLORY HALLER
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 337-831-0191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------