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General NPI Number Information
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NPI Number | 1619662244
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Entity Type | Organization
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Legal Business Name | PROSPER & BLOOM MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 301 MAIN ST STE 2200
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City | BATON ROUGE
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State | LA
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Zip | 70801-0014
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Country | US
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Telephone | 225-605-3103
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Fax |
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Provider Business Mailing Address
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Address Line | 1765 ONEAL LN # 479
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City | BATON ROUGE
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State | LA
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Zip | 70816-1633
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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 | MEMBER
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Name | ANISSA WOMACK
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Credential | PMHNP-BC
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Telephone | 225-605-3103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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