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NPI Code Detail

MEDICARE: STC WELLNESS CENTER, INC

MEDICARE: STC WELLNESS CENTER, INC
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)

General Provider Information

NPI Number : 1649630328
Entity Type Code : Organization
Provider Name (Legal Business Name) : STC WELLNESS CENTER, INC
Provider Business Mailing Address
First Line : 150 CORA DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70815-4201
Country : US
Telephone Number : 225-387-1611
Fax Number : 225-343-5300
Provider Business Practice Location Address
First Line : 150 CORA DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70815-4201
Country : US
Telephone Number : 225-387-1611
Fax Number : 225-343-5300
Authorized Official
Title or Position : CEO/PRESIDENT
Name : MR. DWAYNE J BEASON
Credential :
Telephone Number : 225-387-1611
Provider Enumeration Date : 02/24/2016
Last Update Date : 02/24/2016

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