Provider Demographics
NPI:1033236393
Name:MONPSYCH CARE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MONPSYCH CARE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAMBHAMPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-397-8251
Mailing Address - Street 1:110 ELSINORE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-0170
Mailing Address - Country:US
Mailing Address - Phone:318-397-8251
Mailing Address - Fax:318-397-8251
Practice Address - Street 1:110 ELSINORE DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-0170
Practice Address - Country:US
Practice Address - Phone:318-397-8251
Practice Address - Fax:318-397-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.14626R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1134180Medicaid
LAG22685Medicare UPIN
LA1134180Medicaid