Provider Demographics
NPI:1679007892
Name:RED STICK MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:RED STICK MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CUNEO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-923-8255
Mailing Address - Street 1:3080 TEDDY DR
Mailing Address - Street 2:STE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1925
Mailing Address - Country:US
Mailing Address - Phone:225-923-8255
Mailing Address - Fax:877-761-3087
Practice Address - Street 1:3080 TEDDY DR
Practice Address - Street 2:STE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1925
Practice Address - Country:US
Practice Address - Phone:225-923-8255
Practice Address - Fax:877-761-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health