Provider Demographics
NPI:1821284795
Name:MONROE MENTAL HEALTH
Entity Type:Organization
Organization Name:MONROE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-362-3339
Mailing Address - Street 1:4800 S GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-6412
Mailing Address - Country:US
Mailing Address - Phone:318-362-3339
Mailing Address - Fax:318-362-4174
Practice Address - Street 1:4800 S GRAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6412
Practice Address - Country:US
Practice Address - Phone:318-362-3339
Practice Address - Fax:318-362-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)