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General NPI Number Information
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NPI Number | 1790040939
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Entity Type | Organization
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Legal Business Name | LOUISIANA SUPPORT SERVICES
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 4480 GENERAL DEGAULLE DR
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City | NEW ORLEANS
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State | LA
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Zip | 70131-6941
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Country | US
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Telephone | 504-309-9046
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Fax | 504-309-9216
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Provider Business Mailing Address
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Address Line | 4480 GENERAL DEGAULLE DR
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City | NEW ORLEANS
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State | LA
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Zip | 70131-6941
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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 | OWNER
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Name | MR. WALTER B HARRIS
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Credential |
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Telephone | 252-717-5717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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