Provider Demographics
NPI:1811484819
Name:HATCH, SHUNDRA
Entity type:Individual
Prefix:
First Name:SHUNDRA
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 GENERAL CLEBURNE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6860
Mailing Address - Country:US
Mailing Address - Phone:225-364-6436
Mailing Address - Fax:
Practice Address - Street 1:1707 GARDERE LN STE A1707
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-8144
Practice Address - Country:US
Practice Address - Phone:225-831-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health