Provider Demographics
NPI:1598805624
Name:WINNSBORO-COLUMBIA MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:WINNSBORO-COLUMBIA MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE III
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WRENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-435-2146
Mailing Address - Street 1:1301 LANDIS ST
Mailing Address - Street 2:SUITE - B
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-2642
Mailing Address - Country:US
Mailing Address - Phone:318-435-2146
Mailing Address - Fax:318-435-2134
Practice Address - Street 1:1301 LANDIS ST
Practice Address - Street 2:SUITE-B
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2642
Practice Address - Country:US
Practice Address - Phone:318-435-2146
Practice Address - Fax:318-435-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN086019163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty