Provider Demographics
NPI:1700196912
Name:NORTHSHORE PSYCHIATRIC CARE
Entity Type:Organization
Organization Name:NORTHSHORE PSYCHIATRIC CARE
Other - Org Name:JAMES SHOLTZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-875-7660
Mailing Address - Street 1:107 HIGHLAND PARK PLZ
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7128
Mailing Address - Country:US
Mailing Address - Phone:985-875-7660
Mailing Address - Fax:985-875-7441
Practice Address - Street 1:107 HIGHLAND PARK PLZ
Practice Address - Street 2:SUITE 107
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7128
Practice Address - Country:US
Practice Address - Phone:985-875-7660
Practice Address - Fax:985-875-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10858R2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty