Provider Demographics
NPI:1851047211
Name:MISS LOU
Entity Type:Organization
Organization Name:MISS LOU
Other - Org Name:MISS LOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:225-239-5498
Mailing Address - Street 1:8786 GOODWOOD BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7917
Mailing Address - Country:US
Mailing Address - Phone:225-239-5498
Mailing Address - Fax:
Practice Address - Street 1:4500 LEE RD STE 230
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2959
Practice Address - Country:US
Practice Address - Phone:225-239-5498
Practice Address - Fax:225-239-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health