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General NPI Number Information
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NPI Number | 1699596262
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Entity Type | Organization
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Legal Business Name | EATING DISORDER TREATMENT CENTERS, LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 19375 N 4TH ST
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City | COVINGTON
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State | LA
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Zip | 70433-8876
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Country | US
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Telephone | 920-309-0541
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Fax |
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Provider Business Mailing Address
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Address Line | 19375 N 4TH ST
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City | COVINGTON
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State | LA
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Zip | 70433-8876
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Country | US
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Telephone | 920-309-0541
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EMILY E MEYERS
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Credential | LPC
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Telephone | 920-309-0541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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