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General NPI Number Information
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NPI Number | 1629099502
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Entity Type | Organization
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Legal Business Name | LOUISIANA PSYCHIATRIC CLINIC, LLC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 5225 CAPITOL HEIGHTS AVE SUITE 101
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City | BATON ROUGE
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State | LA
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Zip | 70806-6066
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Country | US
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Telephone | 225-927-4504
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 CAPITOL HEIGHTS AVE SUITE 101
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City | BATON ROUGE
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State | LA
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Zip | 70806-6066
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Country | US
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Telephone | 225-927-4504
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Fax |
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Authorized Official
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Title or Position | CEO MEDICAL DIRECTOR
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Name | DR. JERRY SANDERS
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Credential | M.D.
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Telephone | 225-927-4504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | LA
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