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General NPI Number Information
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NPI Number | 1902172893
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CARE SERVICES OF LA, LLC
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 109 DOUBLOON DR
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City | SLIDELL
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State | LA
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Zip | 70461-2715
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Country | US
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Telephone | 985-641-2513
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Fax | 985-265-4155
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Provider Business Mailing Address
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Address Line | 109 DOUBLOON DR
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City | SLIDELL
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State | LA
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Zip | 70461-2715
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Country | US
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Telephone | 985-641-2513
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Fax | 985-265-4155
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Authorized Official
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Title or Position | SOLE MBR
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Name | GERTRUDE PARKER
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Credential |
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Telephone | 985-641-2513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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