Provider Demographics
NPI:1033552047
Name:NEW BEGINNINGS WELLNESS CENTER AND SPA, LLC
Entity Type:Organization
Organization Name:NEW BEGINNINGS WELLNESS CENTER AND SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-255-1155
Mailing Address - Street 1:1809 NORTHPOINTE LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3852
Mailing Address - Country:US
Mailing Address - Phone:318-255-1155
Mailing Address - Fax:318-255-3181
Practice Address - Street 1:1809 NORTHPOINTE AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3852
Practice Address - Country:US
Practice Address - Phone:318-255-1155
Practice Address - Fax:318-255-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06950208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP06950OtherNURSE PRACTITIONER
LAPA021491OtherPRESCRIPTIVE AUTHORITY