Provider Demographics
NPI:1508301037
Name:MENTAL CONNECTIONS OF SOUTHWEST LLC
Entity Type:Organization
Organization Name:MENTAL CONNECTIONS OF SOUTHWEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:DAUGEREAU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:337-376-0136
Mailing Address - Street 1:PO BOX 1273
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-1273
Mailing Address - Country:US
Mailing Address - Phone:337-376-0136
Mailing Address - Fax:337-376-5244
Practice Address - Street 1:127 WILLIAMSBURG ST BLDG E
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5719
Practice Address - Country:US
Practice Address - Phone:337-376-0136
Practice Address - Fax:337-376-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty