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General NPI Number Information
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NPI Number | 1457396095
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Entity Type | Organization
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Legal Business Name | SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 S MORRISON BLVD
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City | HAMMOND
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State | LA
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Zip | 70403-5409
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Country | US
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Telephone | 985-340-7816
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Fax | 985-340-3834
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Provider Business Mailing Address
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Address Line | 1101 S MORRISON BLVD
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City | HAMMOND
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State | LA
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Zip | 70403-5409
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Country | US
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Telephone | 985-340-7816
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Fax | 985-340-3834
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Authorized Official
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Title or Position | STAFF CLINICAL PSYCHOLOGIST
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Name | DR. JAMES T. RUSSELL
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Credential | PH.D.
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Telephone | 985-340-7816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | 600
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License Number State | LA
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