Provider Demographics
NPI:1184027195
Name:LOUISIANA STATE PSYCHIATRY LLC
Entity Type:Organization
Organization Name:LOUISIANA STATE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-366-7126
Mailing Address - Street 1:6810 JEFFERSON HWY
Mailing Address - Street 2:APT 1309
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6810 JEFFERSON HWY
Practice Address - Street 2:APT 1309
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8175
Practice Address - Country:US
Practice Address - Phone:225-366-7126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-04
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty