Provider Demographics
NPI:1003171026
Name:LURLINE SMITH MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:LURLINE SMITH MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH REGIONAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LADNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:985-624-4450
Mailing Address - Street 1:900 WILKINSON ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 WILKINSON ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3533
Practice Address - Country:US
Practice Address - Phone:985-624-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2083261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health