MEDICARE: NEURO EEG BIOFEEDBACK ASSOCIATES, 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
1	261Q00000X	Clinic/Center		LA

General Provider Information

NPI Number	:	1316228893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO EEG BIOFEEDBACK ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1060 OSCAR GUIDRY RD
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-6213
Country	:	US
Telephone Number	:	337-278-2903
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 LAKESHORE DR
Second Line	:	SUITE 1490
City	:	LAKE CHARLES
State	:	LA
Zip	:	70629-0100
Country	:	US
Telephone Number	:	337-278-2903
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MONIKA ALICE WILLIAMSON
Credential	:	RN, BSN, OCN, LNC
Telephone Number	:	337-278-2903

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	08/29/2011

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