MEDICARE: SERENITY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	1415	LA

General Provider Information

NPI Number	:	1013144732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY CENTER

Provider Business Mailing Address
First Line	:	5615G JACKSON STREET EXT
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2368
Country	:	US
Telephone Number	:	318-443-9246
Fax Number	:	318-443-9247

Provider Business Practice Location Address
First Line	:	5615G JACKSON STREET EXT
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2368
Country	:	US
Telephone Number	:	318-443-9246
Fax Number	:	318-443-9247

Authorized Official
Title or Position	:	COUNSELOR
Name	:	DR. MARY JANE BELFIE
Credential	:	PHD
Telephone Number	:	318-443-9246

Provider Enumeration Date	:	06/20/2009
Last Update Date	:	06/20/2009

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Directions to “SERENITY CENTER ” Practice Location

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