MEDICARE: CHOICES BEHAVIORAL HEALTH AND WELLNESS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1720478951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICES BEHAVIORAL HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	4120 EVE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70125-1934
Country	:	US
Telephone Number	:	888-709-6045
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 EVE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70125-1934
Country	:	US
Telephone Number	:	888-239-3737
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL ROBERT TUCKER
Credential	:
Telephone Number	:	888-709-6045

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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