Provider Demographics
NPI:1205463254
Name:ALLY MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:ALLY MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:225-402-2299
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-1109
Mailing Address - Country:US
Mailing Address - Phone:225-402-2299
Mailing Address - Fax:866-258-9870
Practice Address - Street 1:16270 AIRLINE HWY STE D
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4589
Practice Address - Country:US
Practice Address - Phone:225-402-2299
Practice Address - Fax:866-258-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)