Provider Demographics
NPI:1477870053
Name:BACK TO THE REAL WORLD LLC
Entity Type:Organization
Organization Name:BACK TO THE REAL WORLD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:337-593-0830
Mailing Address - Street 1:234 RUE BEAUREGARD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3285
Mailing Address - Country:US
Mailing Address - Phone:337-593-0830
Mailing Address - Fax:337-593-0122
Practice Address - Street 1:234 RUE BEAUREGARD
Practice Address - Street 2:STE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3285
Practice Address - Country:US
Practice Address - Phone:337-593-0830
Practice Address - Fax:337-593-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11569R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty