MEDICARE: NAMI SOUTHEAST LOUISIANA

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	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578037776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAMI SOUTHEAST LOUISIANA

Provider Business Mailing Address
First Line	:	PO BOX 2055
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70470-2055
Country	:	US
Telephone Number	:	985-626-6538
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 8TH ST
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-4001
Country	:	US
Telephone Number	:	504-368-1944
Fax Number	:	504-368-9784

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	NICK RICHARD
Credential	:
Telephone Number	:	985-626-6538

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	07/23/2024

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Directions to “NAMI SOUTHEAST LOUISIANA ” Practice Location

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