Provider Demographics
NPI:1639395502
Name:M STOGLIN EDD APRN PMH SERVICES, INC
Entity Type:Organization
Organization Name:M STOGLIN EDD APRN PMH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:CNS
Authorized Official - Phone:318-322-8482
Mailing Address - Street 1:300 WASHINGTON ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6714
Mailing Address - Country:US
Mailing Address - Phone:318-322-8482
Mailing Address - Fax:
Practice Address - Street 1:300 WASHINGTON ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6714
Practice Address - Country:US
Practice Address - Phone:318-322-8482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN048404 AP02772364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1688193Medicaid
LA5BD33Medicare PIN
LA1688193Medicaid