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NPI Code Detail

MEDICARE: COMPREHENSIVE MENTAL HEALTH CENTER OF ALEXANDRIA, LLC

MEDICARE: COMPREHENSIVE MENTAL HEALTH CENTER OF ALEXANDRIA, LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
160104OTHERLABCBS

General Provider Information

NPI Number : 1093802795
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPREHENSIVE MENTAL HEALTH CENTER OF ALEXANDRIA, LLC
Provider Business Mailing Address
First Line : 426 N AVENUE G
Second Line :
City : CROWLEY
State : LA
Zip : 70526-4438
Country : US
Telephone Number : 337-785-8003
Fax Number : 337-785-8045
Provider Business Practice Location Address
First Line : 4606 LEE ST
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71302-3235
Country : US
Telephone Number : 318-442-3163
Fax Number : 318-442-4779
Authorized Official
Title or Position : CEO
Name : MARK J CULLEN
Credential :
Telephone Number : 337-785-8003
Provider Enumeration Date : 10/06/2006
Last Update Date : 07/14/2009

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