Provider Demographics
NPI:1164748208
Name:LA BONNE MAISON, LLC
Entity Type:Organization
Organization Name:LA BONNE MAISON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-824-8580
Mailing Address - Street 1:202 LAKE MIRIAM DR STE E13
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2142
Mailing Address - Country:US
Mailing Address - Phone:800-824-8580
Mailing Address - Fax:863-619-7622
Practice Address - Street 1:202 LAKE MIRIAM DRIVE SUITE E13
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:800-824-8580
Practice Address - Fax:863-619-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0004793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty