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General NPI Number Information
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NPI Number | 1700602398
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Entity Type | Organization
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Legal Business Name | LOUISIANA MIND BODY & HEALTH LLC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 5416 HIGHWAY 28 E
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City | PINEVILLE
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State | LA
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Zip | 71360-4756
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Country | US
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Telephone | 318-216-1010
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Fax | 318-302-0504
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Provider Business Mailing Address
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Address Line | 5416 HIGHWAY 28 E
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City | PINEVILLE
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State | LA
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Zip | 71360-4756
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Country | US
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Telephone | 318-216-1010
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Fax | 318-302-0504
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRYSTAL THOMAS
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Credential |
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Telephone | 318-216-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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