Provider Demographics
NPI:1679311609
Name:RESILIENT RECOVERY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:RESILIENT RECOVERY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:318-422-7154
Mailing Address - Street 1:PO BOX 5498
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-5498
Mailing Address - Country:US
Mailing Address - Phone:318-422-7154
Mailing Address - Fax:850-203-1448
Practice Address - Street 1:1007 GOULD DR STE 3
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4971
Practice Address - Country:US
Practice Address - Phone:318-422-7154
Practice Address - Fax:850-203-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty