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General NPI Number Information
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NPI Number | 1427446046
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Entity Type | Organization
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Legal Business Name | DAISY RESOURCES LLC
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 2545 HIGHWAY 4
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City | JONESBORO
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State | LA
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Zip | 71251-6909
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Country | US
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Telephone | 318-439-1399
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Fax | 855-334-8166
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | QUITMAN
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State | LA
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Zip | 71268-0009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BART E LILES
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Credential |
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Telephone | 318-439-1399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LMFT198
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC2361
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License Number State | LA
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