Provider Demographics
NPI:1053975748
Name:CENLA MENTAL HEALTH LLC
Entity type:Organization
Organization Name:CENLA MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:318-613-4762
Mailing Address - Street 1:307 BUCKEYE RIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-8515
Mailing Address - Country:US
Mailing Address - Phone:318-613-4762
Mailing Address - Fax:
Practice Address - Street 1:307 BUCKEYE RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:DEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71328-8515
Practice Address - Country:US
Practice Address - Phone:318-613-4762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty