Provider Demographics
NPI:1699822296
Name:MENTAL RESTORATION INSTITUTE
Entity Type:Organization
Organization Name:MENTAL RESTORATION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-251-1233
Mailing Address - Street 1:300 W ARIZONA AVE
Mailing Address - Street 2:STE. B.
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4306
Mailing Address - Country:US
Mailing Address - Phone:318-251-1233
Mailing Address - Fax:318-254-5023
Practice Address - Street 1:300 W ARIZONA AVE
Practice Address - Street 2:STE. B.
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4306
Practice Address - Country:US
Practice Address - Phone:318-251-1233
Practice Address - Fax:318-254-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty