Provider Demographics
NPI:1457396095
Name:SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:SOUTHEAST LOUISIANA VETERANS HEALTH CARE SYSTEM
Other - Org Name:HAMMOND OUTPATIENT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:985-340-7816
Mailing Address - Street 1:1101 S MORRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5409
Mailing Address - Country:US
Mailing Address - Phone:985-340-7816
Mailing Address - Fax:985-340-3834
Practice Address - Street 1:1101 S MORRISON BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5409
Practice Address - Country:US
Practice Address - Phone:985-340-7816
Practice Address - Fax:985-340-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA600261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA