Provider Demographics
NPI:1467075697
Name:TODD, CHRISTOPHER BRECKENRIDGE (MHSA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRECKENRIDGE
Last Name:TODD
Suffix:
Gender:M
Credentials:MHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14496 AIRLINE HWY APT 417
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6668
Mailing Address - Country:US
Mailing Address - Phone:504-421-3368
Mailing Address - Fax:
Practice Address - Street 1:14496 AIRLINE HWY APT 417
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6668
Practice Address - Country:US
Practice Address - Phone:504-421-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012253625343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)