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NPI Code Detail

MEDICARE: ASCENSION PARISH MENTAL HEALTH AND ADDICTIVE DISORDERS CLINIC

MEDICARE: ASCENSION PARISH MENTAL HEALTH AND ADDICTIVE DISORDERS CLINIC
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
1251S00000XCommunity/Behavioral Health Agency260ALA

General Provider Information

NPI Number : 1770753303
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASCENSION PARISH MENTAL HEALTH AND ADDICTIVE DISORDERS CLINIC
Provider Business Mailing Address
First Line : 1112 S. EAST ASCENSION COMPLEX AVENUE
Second Line :
City : GONZALES
State : LA
Zip : 70737-4265
Country : US
Telephone Number : 225-621-5775
Fax Number :
Provider Business Practice Location Address
First Line : 1112 S. EAST ASCENSION COMPLEX AVENUE
Second Line :
City : GONZALES
State : LA
Zip : 70737-4265
Country : US
Telephone Number : 225-621-5775
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : DR. SUSAN C. MITTENDORF
Credential : PH.D., LCSW
Telephone Number : 225-621-1113
Provider Enumeration Date : 03/11/2008
Last Update Date : 03/11/2008

Similar Medicare Providers

1194758961 — MR. RYAN D RIFE LCSW
Practice Location Address:
1112 E ASCENSION COMPLEX BLVD
GONZALES, LA
70737-4265
Practice Phone: 225-621-5770
Practice Fax: 225-644-3208
1841217718 — MELISSA SHAW MSW
Practice Location Address:
1112 E ASCENSION COMPLEX BLVD
GONZALES, LA
70737-4265
Practice Phone: 225-621-5770
Practice Fax: 225-644-3208
1376560144 — DONNA M BOUDREAUX RN
Practice Location Address:
1112 E ASCENSION COMPLEX BLVD
GONZALES, LA
70737-4265
Practice Phone: 225-621-5770
Practice Fax: 225-644-3208
1528087905 — DAVID E POST M.D.
Practice Location Address:
1112 E ASCENSION COMPLEX BLVD
GONZALES, LA
70737-4265
Practice Phone: 225-621-5770
Practice Fax: 225-644-3208
1457370801 — MR. GREGORY P QUARTANO LCSW
Practice Location Address:
1112 E ASCENSION COMPLEX BLVD
GONZALES, LA
70737-4265
Practice Phone: 225-621-5770
Practice Fax: 225-644-3208
1568483378 — SUSAN A GAUTHIER RN
Practice Location Address:
1112 E ASCENSION COMPLEX BLVD
GONZALES, LA
70737-4265
Practice Phone: 225-621-5770
Practice Fax: 225-644-3208
1063433787 — SHARON B KERNAN RN
Practice Location Address:
1112 E ASCENSION COMPLEX BLVD
GONZALES, LA
70737-4265
Practice Phone: 225-621-5770
Practice Fax: 225-644-3208

Directions to “ASCENSION PARISH MENTAL HEALTH AND ADDICTIVE DISORDERS CLINIC ” Practice Location

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