Provider Demographics
NPI:1720111230
Name:EQUIPOISE WELLNESS CENTER
Entity Type:Organization
Organization Name:EQUIPOISE WELLNESS CENTER
Other - Org Name:SPRINGFIELD WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-294-5955
Mailing Address - Street 1:32900 PITCHER RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:70462-8334
Mailing Address - Country:US
Mailing Address - Phone:225-294-5955
Mailing Address - Fax:225-294-5955
Practice Address - Street 1:32900 PITCHER RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:LA
Practice Address - Zip Code:70462-8334
Practice Address - Country:US
Practice Address - Phone:225-294-5955
Practice Address - Fax:225-294-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1907101YP2500X
LAL0127462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty