Provider Demographics
NPI:1780011098
Name:PONTCHARTRAIN PSYCHOLOGICAL RESOURCES, LLC
Entity Type:Organization
Organization Name:PONTCHARTRAIN PSYCHOLOGICAL RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:985-590-8096
Mailing Address - Street 1:70452 HIGHWAY 21
Mailing Address - Street 2:200 #116
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8116
Mailing Address - Country:US
Mailing Address - Phone:985-590-8096
Mailing Address - Fax:
Practice Address - Street 1:70452 HIGHWAY 21
Practice Address - Street 2:200 #116
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8116
Practice Address - Country:US
Practice Address - Phone:985-590-8096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty