| NPI | 1659814689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHTIN ANIO Mentall Health Professional 225-244-3650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 12883) |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2016-11-22 |