Provider Demographics
NPI:1225577323
Name:MUNDY, DENISER
Entity Type:Individual
Prefix:MRS
First Name:DENISER
Middle Name:
Last Name:MUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 VETERANS BOULEVARD SUITE. 105
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062
Mailing Address - Country:US
Mailing Address - Phone:504-305-4704
Mailing Address - Fax:504-305-4709
Practice Address - Street 1:2200 VETERANS BOULEVARD SUITE. 105
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062
Practice Address - Country:US
Practice Address - Phone:504-305-4704
Practice Address - Fax:504-305-4709
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health