=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972258176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENLA PSYCHIATRY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2022
-----------------------------------------------------
Last Update Date | 02/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5615 JACKSON ST STE D
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71303-2326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-442-9999
-----------------------------------------------------
Fax | 318-442-9976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7231
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71306-0231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-664-4786
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GENE THOMAS ROBICHAUX JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 318-664-4786
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------