Provider Demographics
NPI:1073015574
Name:LA PAZ, LLC
Entity Type:Organization
Organization Name:LA PAZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKYSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKS-SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:318-224-9200
Mailing Address - Street 1:910 S VIENNA ST STE 7
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5864
Mailing Address - Country:US
Mailing Address - Phone:318-224-9200
Mailing Address - Fax:318-224-9201
Practice Address - Street 1:910 S VIENNA ST STE 7
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5864
Practice Address - Country:US
Practice Address - Phone:318-278-0309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care