Provider Demographics
NPI:1073863189
Name:COLLABORATIVE MINDS, LLC
Entity Type:Organization
Organization Name:COLLABORATIVE MINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:504-400-2477
Mailing Address - Street 1:10517 KENTSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2853
Mailing Address - Country:US
Mailing Address - Phone:225-456-2884
Mailing Address - Fax:225-456-2892
Practice Address - Street 1:7902 WRENWOOD BLVD
Practice Address - Street 2:SUITE A.
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1794
Practice Address - Country:US
Practice Address - Phone:225-456-2884
Practice Address - Fax:225-456-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health