Provider Demographics
NPI:1578619904
Name:EASTERN LOUISIANA MENTAL HEALTH
Entity Type:Organization
Organization Name:EASTERN LOUISIANA MENTAL HEALTH
Other - Org Name:NEW IBERIA MENTAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH CENTER MANAGER A
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:337-373-0002
Mailing Address - Street 1:611 W ADMIRAL DOYLE DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-6408
Mailing Address - Country:US
Mailing Address - Phone:337-373-0002
Mailing Address - Fax:337-373-0129
Practice Address - Street 1:611 W ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6408
Practice Address - Country:US
Practice Address - Phone:337-373-0002
Practice Address - Fax:337-373-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty