Provider Demographics
NPI:1073747374
Name:NURSING HOME PSYCHOLOGICAL SERVICES OF LOUISIANA LLC
Entity Type:Organization
Organization Name:NURSING HOME PSYCHOLOGICAL SERVICES OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HESSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:256-825-4135
Mailing Address - Street 1:398 E COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-1402
Mailing Address - Country:US
Mailing Address - Phone:256-825-4135
Mailing Address - Fax:256-825-4137
Practice Address - Street 1:109 CONSTELLATION DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-9029
Practice Address - Country:US
Practice Address - Phone:256-825-4135
Practice Address - Fax:256-825-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty