Provider Demographics
NPI:1275939266
Name:HIGGINS PSYCHOLOGICAL SERVICES, A PROFESSIONAL PSYCHOLOGICAL CORP
Entity Type:Organization
Organization Name:HIGGINS PSYCHOLOGICAL SERVICES, A PROFESSIONAL PSYCHOLOGICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:504-885-1442
Mailing Address - Street 1:4500 CLEARVIEW PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2351
Mailing Address - Country:US
Mailing Address - Phone:504-885-1442
Mailing Address - Fax:
Practice Address - Street 1:4500 CLEARVIEW PKWY STE 201
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2351
Practice Address - Country:US
Practice Address - Phone:504-885-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA525261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S708Medicare UPIN