Provider Demographics
NPI:1750575684
Name:THE STRESS CLINIC
Entity type:Organization
Organization Name:THE STRESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:VAN BUREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-323-6162
Mailing Address - Street 1:2215 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2215 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3623
Practice Address - Country:US
Practice Address - Phone:318-323-6162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
436-26-17660OtherBLUE CROSS/BLUE SHIELD